An Introduction To Community Psychology

An Introduction to Community
Psychology

An Introduction to
Community Psychology

MELVIN ZAX
University of Rochester

GERALD A. SPECTER
University of Maryland

MLSU " CENTRAL LIBRARY

Copyright © 1971 by John \\ iley & Sons Inc

All rights reserved Published simultaneously tn Canada

No part of this book may be reproduced by any means nor
transmuted nor translated into a machine language with
out the written permission of the publisher

Ubrary of Congress Cataloging m Publication Data
Tax Melun

\n introduction to community psychology

1 Community psychology I Specter
Gerald A joint author II Title
lOSLM 1 Community mental health services
2 Pyschology Social \\M30Z39i 1971]

3022 01*2 73 201D0

ISBN 0-171 OS1J5-4

Printed in the United States of America
10 9 ft 7 0 5 n

Preface

The most recent revolutionary development in psychology and the men-
tal health fields in general involves a variety of approaches to behavioral
and social problems that implicate the community both as a causative factor
and as a potentially therapeutic agent. This development has been of suf-
ficiently great magnitude to be described by Nicholas Hobbs as the '‘third
mental health revolution.” Thus he gives community psychology an im-
portance equal to that of the humanitarian reforms in hospital care pro-
mulgated by Pinel and others in the late 18th century, and to the monu-
mental contributions of Freud in the late 19th and early 20 th centuries.
Clearly, the general concept of community psychology has enjoyed wide
acceptance and has stimulated the development of exciting and daring new
approaches to dealing with man's mental health problems.

In the rush to develop these approaches and to make operational new
new and drastically different ideas about ways of providing service, much
that has been written about the field has been fragmented. Writings have
referred to isolated programs or to the development of ideas associated
with program building in a specific area. Many collections of these writings
have been edited and set forth for the student who would like to deepen
his understanding of what is occurring. These readings have been helpful
but have been inevitably limited, and they have failed to provide overall
scope with respect to the many areas on which community psychology is
having an important impact. This mode of communicating typifies a field's
earliest stages of development. Now, however, sufficient work has proli-
ferated in community psychology so that a broad coverage of the field is
needed. It is for this reason that this book has been written. Intended as an
introduction to the field of community psychology, it describes the histori-
cal roots out of which the field has grown, provides a broad sampling of die
types of endeavors that are seen as falling under the rubric of community

VI / PREFACE

psychology, and communicates an understanding of what has been accom
pUshed m the field, what problems must be dealt with and how much is
yet left to be done

As a textbook, this work is of interest to both graduate and undergrad-
uate students who require a broad survey of community psychology It
also is of interest to many graduate and undergraduate students who are
currently involved m some type of community psychology program One
characteristic of community psychology is that it draws large numbers of
relatively untrained people into various kinds of human service work on
a career, on a part time, or a temporary volunteer basis Many college stu
dents who are in these categories are presently engaged in projects of van
ous kinds for university credit and even in activities that are not sponsored
under university auspices or credited in the usual academic fashion
The book provides these students with a sense of perspective about the
kind of work that they are doing and their reasons for doing it It also
conveys a feeling for the experiences of others who are engaged in similar
enterprises and the satisfactions and problems that they have encountered
in this work

We were inspired to wnte this book as the result of our own expen
ences over a period of years in developing various types of community pro-
grams, an exercise that has helped to build considerable commitment to
the worth of community approaches In these enterprises, we have been
joined by a number of colleagues, alt fellow students in a very exciting new
venture We extend our gratitude to all these individuals who, on read
ing this work, will recognize their own contributions One who must be
singled out for special mention is Emory L Cowen, whose energetic interest
m a variety of practical programs involving both of us, as well as the
stimulation that he provided in thinking through with us many of the
problems and issues in this field, have been of inestimable value Our
special thanks also go to James G Kelly, Brendan A Maher, and Charles
Spielbcrger who read the entire manuscript, provided the encouragement
tse needed to push ahead with the project, and made many constructive
criticisms that led to a much better manuscript than could have been pro
duced without their help

Finally, our typists Mrs Hannah Berner and Mrs Cathleen Allen,
deserve a special mention They have borne a heavy burden with good
humor and efficiency above and beyond the call of duty

MELVIN ZAX
GERALD A SPECTER

Co?itents

lk. Introduction I

2. .Recen t Impetus for Community Approaches 28

3. Community Programs for Traditional Problems in Schools,

Clinics, and Hospitals 54

4. Restructuring the Hospital Community 81

5. Programs for Infants and Preschool Children 125

6. Primary Prevention in the Schools 147

7. Secondary Prevention in the Schools 173

8. Prevention in the College Community 202

9. Prevention Programs in the Greater Community 228

10. The Creation of Growth Enhancing Settings 278

ll. Criticisms of Changing Mental Health Approaches 314

12. Training for New Professional Roles 337

13. The "Nonprofessional’' in Community Psychology Programs 369

14. The Role of the Community in Community Psychology 394

15. Research in Community Psychology 420

16. Summary and Prospects 458

Index *75

An Introduction to Community
Psychology

I. hitroduction

In a historical survey of clinical psychology, Hersch (1969) set the birth
date of community psychology as May 1965 During that month a group
of psychologists actively engaged in developing community mental health
programs met in Boston under the joint sponsorship of Boston University
and the South Shore Mental Health Center of Quincy, Massachusetts to
consider the education of psychologists for work in community mental
health (Bennett, Anderson, Cooper, Hassol, Klein, and Rosenblum,
1966 ) In discussing the role of the community psychologist, the Boston
conferees were inevitably defining the area of community psychology
They characterized community psychologists as ‘ change agents, social
systems analysts, consultants in community affairs, and students gen
erally of the whole man in relation to all his environments ' (Bennett,
1965, p 833) Many of the participants favored broadening the com
munity psychologist s role through his going beyond consultation to be

2 I introduction

come a political activist who assumes decisionmaking powers The com
mumty psychologist was further urged to use his scientific training to ere
ate knowledge and promote programs, thereby functioning as a partia
pant conceptualizer’ (Bennett et al , 1966)

The Boston conference generated much thought about community psy
chology and stimulated the establishment of a division of Community
Psychology within the American Psychological Association and the crea
tion of several university training programs However, if the Boston con
ference marked the birth of community psychology, several earlier dis-
cussions and statements about the role of the psychologist in the mental

health field must be acknowledged as contributors to its conception

Sanford (1958) , speaking as a member of the Joint Commission on
Mental Illness and Health, a presidential commission established to study
the mental health needs of the nation, spoke eloquently in 1958 in favor
of the psychologist’s playing a fuller role in the mental health movement
He said I want to predict that the mental health movement, as a social
and cultural phenomenon, will move in this positive direction, with em
phasis on promotion of resiliency and creative living I want to observe
that psychologists, if they can devote their fertile minds to the problem, if
they do not adjust too much to the clinical medical way of life, can make
an enormous social contribution to this kind of mental health movement”

(p 84) In this paper, Sanford chided psychology for being diffident with
respect to important public issues and urged that the field renounce its
exclusive focus on clinical problems in favor of new approaches to deal
not only with the sick or troubled but also with those manifesting less ob
vious problems Much of what Sanford proposed in 1958 was very simi
Iar to the views of community psychology that emerged from the Boston
conference several years later

A few years after Sanford s paper appeared, Gelfand and Kelly
(1960) wrote a short endorsement of Sanford s recommendations They
added, however, that in addition to assuming new community roles out
side of clinics and hospitals psychologists needed to bring to bear their
scientific expertise on the problem of developing an orientation toward
health This expertise, these authors believed, represents the truly unique
contribution that psychology can bring to the emerging field of commuiu
ty psychology

In describing a training program m "community clinical psychology,”
Jones and Levine (1963) also affirmed the need to reject an illness or
disease model in favor of greater concern for promoting healthy behavior
or optimal functioning Here, again, was a view of an applied area of psy
chology consonant with the view of community psychology that was to
emerge from the Boston conference

Subsequent to the Boston conference, Retff (1968) spoke passionately

INTRODUCTION / 3

of a need for the community psychologist to develop a new conceptual
outlook that would permit the professional to intervene m a social system
on behalf of some aggregate of individuals needing assistance He assert
ed that the clinical skills used to intervene in behalf of an individual la
beled schizophrenic the skills with which mental health professionals are
most familiar, are of little use m the new venture m the community Thus
Reiff called for the development of a new school of psychology

Interestingly, in these examples of statements made directly and mdi
rectly about community psychology, there seems to be relatively little
variability about the direction the field ought to take Each example calls
for a renunciation of the exclusive concern for the mentally ill Each m
sists that psychology should develop a greater concern for the healthy ad
aptation of large masses of individuals only a few of whom are likely to
end up as mental patients The only points on which variability or disa
greements seem to arise involve the question of how far the psychologist
should go in attempting to shape the healthy community Some would
stop at the point of becoming consultants to influential, power wielding
agents of society Others would go so far as to inject themselves into the
power structure where they could themselves hold the administrative
reins

Since the selection of material included in this book requires a working
definition of community psychology to serve as a guide, we have extract
ed a common denominator running through the many conceptions used
to characterize this field Also we have made an effort to achieve a view
that is broad enough to encompass the diverse service programs tending
to be classified as community approaches On this basis

Community psychology is regarded as an approach to human behavior
problems that emphasizes contributions made to their development by
environmental forces as well as the potential contributions to be made
toward their alleviation by the use of these forces

Such a definition stresses a shift in thinking away from concentration on
intrapsychic dynamics in considering all manner of behavior problems
including those falling within the traditional domain of the clinician, and
allows for actve preventive interventions

It would be a mistake to come away from this discussion with the 1 m
pression that the elements of community psychologys approach are
unique to practitioners within the field of psychology itself Actually,
community psychology has emerged within a context in which all of the
mental health professions have manifested considerable concern regard
ing the role of environmental forces in creating behavioral problems

This concern has found expression at the federal level in a commission
established by the Mental Health Study Act of 1955. consisting o£ lead

4 / introduction

ins members of the mental health professions. This group U° im Com-
mission on Mental Illness and Health, 1961) was charged with conduct-
ing a thorough, objective study of the mental health needs of the nation
and with recommending steps that the federal government might take to
alleviate these needs. Their recommendations included the establishmen
of broad-scale mental health centers to be made available for each
50,000 of the general population. The functions of these centers were e-
scribed to include treatment for traditional mental health disorders, par-
ticularly acute ones, care for mental patients not yet requiring hospitali-
zation or for others who had been discharged from hospitals, and to serve
as a base for consultation with various community agents capable of pro-
viding mental health services. Thus the guidelines for community mental
health centers included a balance between service for manifest mental ill-
ness as well as preventive efforts. For many (Golann and Eisdorfer,
1972) the establishment of community mental health centers was viewed
as an opportunity for the mental health professions to intervene in the so-
cial context within which many problems breed.

In keeping with the rising concern for community mental health, many
individuals in a variety of social service fields have hoped that traditional
approaches to dealing with mental health problems could be made more
flexible. Furthermore, recognizing that the traditional mental health agen-
cy has badly neglected large segments of our population, particularly the
poor and the educationally underprivileged, many have called for in-
creased community participation in the management and operation of
mental health centers. This, hopefully, would ensure that the services of-
fered would be those that are badly needed by the community rather than
only those that mental health professionals trained in a traditional mold
and coming from a particular social class are comfortable in providing.
As we discuss in chapters that follow, efforts to revise traditional struc-

tures and to innovate as a means of providing broader services have re-
sulted in exciting new departures. Mental health agencies have reached
out to school systems, lower class neighborhoods, community political
and administrative structures, and a myriad of other settings that have
been virtually ignored up to this time. In the process, a variety of new
types of mental health workers have developed. Furthermore, many of
these programs have differed in purpose from the traditional goals of the
clinic Thus community approaches represent a revolutionary departure
within all the mental health fields that has been innovative and exciting
from many viewpoints. These approaches have also created a variety of
stresses and strains within the mental health fields. The new conceptions
that these approaches have engendered concerning the way service
should be delivered, who should be the recipient of such services, who
should provide them, and where they can most profitably be provided has
been the source of interest, excitement, upset, and threat.

DEFINITIONS / 5

To place community psychology within a context that includes other
mental health professions, it is well to review a few terms that have the
modifier "community," such as community psychiatry and community
mental health, as well as the term, social psychiatry, which has been
widely used in recent years with reference to activities that sound suspi-
ciously similar to many that characterize the community approaches.

DEFINITIONS
Community Psychiatry

At one extreme are those who view community psychiatry as having
precisely the same aims as traditional psychiatry, the treatment of mental
illness, but differing from it methodologically. Whereas the traditional
psychiatrist focuses exclusively on the patient, the community psychiatrist
grants considerably more significance to the social forces acting on the
patient and focuses on them as well. This position is held by Bernard
(1964) who, even more traditionally, regards community psychiatry as a
psychiatric specialty, hence, one requiring medical training for all its
practitioners. Beliak’s (1964) definition of community psychiatry as “the
resolve to view the individual’s psychiatric problems within the frame of
reference of the community and vice versa” (p. 5) also falls in this cate-
gory. Another example of a definition that focuses on mental illness is of-
fered by Loeb (1969, p. 235) : “Community psychiatry is the use of
community resources in addition to interpersonal and intrapersonal re-
sources to help mentally ill and emotionally disturbed people achieve
greater personal and social adequacy.” Other writers (Dunham, 1965;
Halleck, 1969; Mechanic, 1969) , although not offering specific defini-
tions of their own, indicate by their critiques and admonitions about the
evolving community psychiatry that this new field should not go beyond
the bringing to bear of a solid understanding of social forces on the prob-
lems of the traditional psychiatric patient.

At the other extreme are those who, although agreeing that a major
mission of community psychiatry ought to be the treatment and rehabili-
tation of patients suffering the problems traditionally dealt with by the
psychiatrist, consider prevention of the development of mental disorder
as an equally significant function. Thus Hume (1964) lists consultation
to educational and nonpsychiatric agencies and public information pro-
grams as services to be rendered by community psychiatry. Caplan
(1965) asserts that community psychiatry deals with entire populations,
all age, cultural, and socioeconomic groups whether agency cases or not.

He goes even further in specifying that part of the preventive function of
the community psychiatrist is to collaborate actively with a variety of civ-

6 / introduction

,c leaders and government administrators >n an effort to reshape the
structure of the community to mate it a psychologically healthier place in
which to live Dull! (1965) holds that the community psychiatrist must
not only provide service for those suffering traditional mental illness and
attempt to prevent development of such illness but must also tackle the
broader problems of human concern today— poverty, unemployment se
cunty and recreation To this end he feels that community psychiatry
must also be concerned with the normal growth of the general popula
tion

From a practical as well as theoretical viewpoint these two views of
community psychiatry are poles apart One position clings to a traditional
view of the problems to which mental health professions should address
themselves The other greatly expands the scope of the profession and by
doing so brings the psychiatrist as well as other mental health workers
into contact with people and roles that are entirely new to him as a pro-
fessional

Social Psychiatry

The term social psychiatry is also defined in various ways with major
definition'll differences relating to the issue of whether it refers to an ap
plied or to an exclusively theoretical field Leighton s definition (quoted
in Goldston 1965 p 198) states

In the United States the term usually brings to mind preventive com
munity programs, industrial and forensic psychiatry, group therapy , the
participation of psychiatry in administrative medicine the utilization of
the social milieu in treatment, and the study of social factors in the etiolo
gy and dynamics of mental illness

Tins viewpoint places the major emphasis on the application of social
psychiatry to a number of psychiatric problems In this respect it overlaps
considerably with urtually all definitions of community psychiatry The
same may be said for other definitions such as that offered by the World
Health Organization (quoted m Goldston 1965 p 199)

social psychiatry refers to the preventive and creative measures
it htch arc directed tonards the setting of the individual for a satisfactory
and useful life in terms of hts own social environment Jn order to
achieve this goal the social psychiatrist attempts to provide for the men
tally ill, and for those in danger of becoming so, opportunities for making
contacts i nth forces which are favorable to the maintenance or reestab
Ushment of social adequacy "

On the other hand many \iew social psychiatry as a field of research
and study that contributes useful information to the community psychia

DEFINITIONS } 7

tnst but tint is itself not concerned ruth applications This is clearly stat
ed by Redlich and Pepper (quoted in Goldston 1965 p 198)

"Our own brief definition, influenced by Rennie, defines .social psy
chiatry as the study of psychiatric disorders and psychiatric therapy,
hopefully including prevention, within a social setting This implies that
social psychiatry is defined as an exploration of social systems and cul
ture and their impact on psychiatric phenomena rather than as a type of
psychiatric practice M

Along similar lines Srole (1965) says in comparing social and commum
ty psychiatry

“Social psychiatry can be marked off from community psychiatry
somewhat arbitrarily perhaps but I think meaningfully by its different
priority orientations, timetable, methods and personnel requirements 1
have just suggested that community psychiatry s research function , tends
to be a secondary priority, of the operational ( applied ) kind needed
facilitate, assess, revise, and enlarge its service and (mming iiclimliM

- •*— »

Several others maintain a distinction between community and social psy
chiatry that is similar to Srole s (Kahn 19 a s un

In summary when social psych.a.ry rs viewed^ having i. ban^ap.

plied component tt overlaps consI er “ J manly an area o£ study and
munity psychiatry When it is regar e P existence as a potentially
research social psychiatry maintains a P ^ lt JS devoted to un

useful contributor to community psyc i that the

demanding the effects on individual behavior of the social
community psychiatrist seeks to mampu ate

Community Mental Health

f that we ha ve discussed thus far community
As is true for the concepts tha ways Goldston (1965 p

mental health is defined in broa y Community mental health

198) quotes one brief definition tha provision of a variety of

refers most frequently to the administra i n speaking of the com

mental health services Likewise Be ( dcvelo „ d stresses their fo-
mumty mental health centers t lat ar services day and night hospi

cus on traditional diagnostic an tre “ , ment c f mental health infor

tal care foster home care an t ie viewpoints are very sum

mation programs for the genera P u , - . ons D f community psychiatry

lar to many relatively ^ “*

that have been discussed i 1 P

8 / introduction

those that have become traditional tor the mental health fields The only
innovation involved is that a broader outlook is taken concern, ng etiology

“onThTmher hand a number o£ people whose definitions differ m
many respects agree in viewing community mental health much more
broadly Bernard (1964) sees community psychiatry as a component of
the more inclusive field of community mental health Hume (1964) feels
that community mental health programs unlike community psychiatry,
are directed toward normals with the aim of promoting positive mental
health Kahn (1969 p 187) views the community mental health func
tion as a general coalition of people and organizations which comes
together around social goals and which consists of many loosely mterre
lated components from several intervention systems and social institu
tions joined together for the purpose

The extremely broad outlook regarding goals and involved agencies
that characterizes Kahn s view typifies the outlook of many others Lemk
au (quoted m Goldston 1965 p 197) sees community mental health as
inclusive of community psychiatry and states

Thus we have the concept emerging that community mental health is
a communitywide responsibility, that the program is to be under profes
sional and lay auspices and that mental health is promoted and fostered
not solely through medical treatment, but also through a variety of institu
tions and agencies with numerous disciplines joining in the effort '

Similarly Howell (quoted in Goldston 1965 p 197) states

Community mental health encompasses all activities which are in
volved in the discovery development and organization of every facility
in a community which effects all attempts which the community makes to
promote mental health and to prevent and control mental illness

Another such example is offered by the psychiatric staff of a prominent
clinic (quoted in Goldston 1965 p 197)

This (community mental health) is the broad multidisciphned field
concerned with the wide variety of forces and structures m a community
which affect the emotional stability (positive growth development , and
functioning) of a significant group of its members It is contrasted with
the traditional clinical approach which focuses on the particular indivtdu
al in emotional distress

In summary the narrowest conceptions of the term community mental
health fail to distinguish it bom a narrow view of community psychiatry
Broader views of the concept which seem incidentally to be more prev
alent encompass all community forces affecting the psychological state

CHANCING CONCEPTIONS OF MENTAL DISORDER [ 0

of most members of the community. Its goals are not only the alleviation
of suffering but the promotion of positive growth as well. Its agents are
not just psychiatrists or even mental health professionals, but any com-
munity agents or agencies capable of contributing to cure, prevention, or
optimal development.

Since community psychology and other current community approaches
are, at least, in part, outgrowths of clinical psychology and psychiatry, the
historical roots of these disciplines are to be found in the same soil. Es-
sentially, community psychology may be viewed as a theoretical outlook
and a method of practice that has evolved out of clinical psychology, in
keeping with the reasonably orderly change that has taken place in think-
ing about mental illness over many years.

CHANGING CONCEPTIONS OF MENTAL DISORDER

To understand theories about mental or behavioral disorder, and to grasp
why professionals treat this disorder as they do, one must first specify just
what behavior is regarded as disordered. A careful study of the history of
thought regarding this human problem reveals that conceptions of behav-
ior considered to be disordered or abnormal have not been constant. Ref-
erences in ancient writings to abnormal behavior include examples such
as epileptic seizures, severe depression, grandiose delusions, and severe
mental deterioration. Homeric writings describe the insane Ajax as killing
sheep instead of his enemies. In his attempt to appear mad, Ulysses is de-
scribed as yoking a bull and horse together, plowing the sand, and sowing
salt rather than seeds. Other mentally aberrant mythological figures are
described as hallucinating or running through the forests bellowing like
animals.

Hippocrates, the Greek physician considered to be the father of all medi-
cine, wrote many good descriptions of what were seen as mental disor-
ders in his time. These include what we would now call postpartum
psychoses ( usually a severe depression following childbirth) and the deliri-
ous states sometimes associated with high fever. He also described epilep-
sy, mania (extreme excitement) , melancholia (severe depression) , ex-
treme intellectual deterioration and alcoholic delirium similar to what we
term delirium tremens (the DTs) .

Imperial Rome imported Greek medicine and produced many out-
standing practitioners who also wrote of the mental disorders of their
time. Thus Roman physicians described depression and delirious states as
well as a condition characterized by "stupefaction of the sense of reason
and other faculties of the mind." In some cases, the latter condition in-
volved so severe a mental deterioration that "sensibility and intelligence

10 / introduction

fall into such a degree of degradation that, plunged into an absolute fatu
ousuess they forget themselves pass the remainder of their b^sasbrute
beasts, and the habits of their bodies lose 'dl human dignity Many .
recognize m this descnption elements of a disorder that many centuries

later came to be called schizophrenia

The Middle Ages saw a decline in the Tidiness of thought and observa
non that characterized the Greek and Roman cultures Nonetheless, it is
apparent that mental disorders which characterized earlier times were
prevalent during the Middle Ages and, in addition, a few behavioral ab
errations appeared that were unique to the period such as the group phe-
nomenon involving large processions of people who, believing the world
was about to end, traveled about the countryside doing public penance

for their sinful behavior These people, known as flagellants, earned ban
ners, crosses, and candles Their entirely black costume was marked by a

red cross, and they carried heavy leather whips, often metal tipped, with

which they flogged themselves until blood flowed

Doubtless, these peculiar behavioral phenomena of the Middle Ages
were induced by the stark religiosity of the time The flagellants were, un
doubtedly, frightened, guilty people with an overwhelming need to ex
piate their sins For some reason ordinary church ritual did not suffice
for them

From the end of the Middle Ages through the 19th century, man’s
conception of what was behaviorally abnormal continued to emphasize
the types of disorders already described Many efforts were made to clas
sify behavioral aberrations and new terminology was introduced from
time to time, but relatively few new conditions were described Perhaps
the most significant contribution of the 19th century to what was thought
of as behaviorally abnormal was the concept of dementia praecox, out of
which grew the entity known as schizophrenia Dementis praecox, popu
larized by Emil Kraepelin encompassed several disorders that had
been recognized earlier but had not necessarily been associated with each
other

The salient point of this brief review of behavior considered to be ab
normal up to the 20th century is that mental disorder was in the past al
most exclusively associated with extreme and dramatic behavioral de
viancy To be sure, a few behavioral disorders less extreme than what are
now considered psychoses were noted by some For example, hysteria,
no ' v looked on as a psychoneurosis, was described by Hippocrates and
later physicians This condition however, often characterized by dramat
ic physical symptoms (paralyses, anesthesias, blindness, etc) which fail
to respect physiological facts, must have appeared to the ancient healer as
a \ery serious disorder

Ollier disorders more subtle than hysteria were also noted in early

CHANCING CONCEPTIONS OF MENTAL DISORDER / H

times b> particularly sensitive observers but these did not attract the in
terest of the mental health professions of the day The Roman philoso-
pher Cicero described grossly antisocial behavior which might now be
called sociopatlnc as resulting from mental disorder Arabian physicians
described the ruminations and anxiety that typify a disorder we now call
obsessive compulsive neurosis Around ad 400 a Roman physician
characterized various sexual perversions common at the time as the
product of mental disorder Each of these was however largely an isolat
ed insight having no significant impact on thought concerning mental dis
order and its treatment

It appears that man approached the task of self-examination gingerly
For many hundreds of years he was concerned only with behavior that
was so different from the ordinary that those manifesting it seemed al
most other than human

The work of Sigmund Freud which began at the end of the 19th cen
tury culminated m a major mental health revolution and was the impetus
for several significant revolutions that followed The revolutionary aspect
of Freud s work derived in part of course from the content of the theo-
ries he expounded but it also resulted from his experiences with hysterics
and psychoneurotics Freud was not trained m any of the traditional
mental health professions of his time and like many physicians he came
in contact with numerous patients whose problems seemed more psycho-
logical than physical Not being psychotic however they were ignored by
the psychiatrists of the day Such individuals were usually treated by gen
eral practitioners m the best of circumstances and otherwise by quacks
faith healers or charlatans Since Freud was a neurologist many hyster
ics whose overt symptoms seemed to be neurological were referred to
him One very significant effect of Freuds work with such patients was a
redefinition of the scope of the mental health field

The quality of Freud s work and thought his explanations of how neu
roses developed and his apparent success in treating them by psychologr
cal means attracted wide interest among those concerned with mental dis-
orders To be sure many of Freud s ideas were adapted for application to
the serious psychoses with which most traditional mental health workers
of the time were grappling Still a significant segment of the field came to
accept neuroses far less disabling than psychoses as problems worthy of
concern and effort In so doing the services of the mental health worker
came to be called on by a much larger percentage of the population than
ever before and the terms abnormal or disturbed were applied to symp-
toms such as severe anxiety phobias disabling compulsions hysterical

complaints and the like

In addition to encouraging the mental health professions to accept psy
choneuroses as a part of them area of concern Freud expounded a theory

12 / introduction

of personality development that prompted still further «°P c br ° at j' :n ' n S
redefinitions of what was abnormal H.s efforts at understanding *ver*
behavioral phenomena were guided by the essential faith that all behavior
could be explained deterministically and his theory emerged out of his
experience with the patients who came to him Psychoanalytic theory
placed great stress on biological forces but it also acknowledged the im
portance o£ the interaction between biological drives and the environment
in which they are expressed Thus two people with similar urges of equiv
alent force might deal with these urges quite differently depending on
how various behaviors are reacted to by those with whom each must live
Therefore great stress was placed m the theory on the role of life expen
ence in shaping personality Furthermore in pointing up the various ways
personality problems might arise m the course of development Freud
was also describing the kind of experiences that could lead to optimal de
velopment and what he regarded as the normal personality

Freud s theories as well as the therapeutic efforts of his followers led
to several later redefinitions of what was regarded as psychologically ab
normal One such redefinition resulted in the emergence of the field of
psychosomatic medicine Once theories were advanced concerning the
role of the psyche in causing maintaining or exacerbating physical ill
ness the scope of the mental health field was again broadened considera
bly Whereas the mental health professional had focused for centuries on
psychoses within a few short years he found himself becoming concerned
about psychoneuroses and a variety of physical complaints that were sus
pected to have essential psychological components

A still more broadening redefinition of the mental health field was to
arise with the introduction of the concept of character disorder The de
velopment of this concept did not come about suddenly nor can it be as
yi/saf&L ’M'yiV eA pernm Yrn’rraps the earnest suggestion

of the concept of character disorder can be attributed to Wilhelm Reich
(1949) In the mid 1920s Reich one of Freud s students wrote a book
on psychoanalytic technique As one of the pioneer practicing analysts
Reich had believed that most of man s problems derived from trouble
some inner urges that could neither be permitted free expression nor
completely prevented from affecting behavior These urges were thought
to reside in an aspect of the human psyche known as the id It was felt
that the prime task of psychoanalysis was to bring troublesome id forces

to consciousness where they could be dealt with more effectively by an
other psychic agency postulated by Freud the ego The ego was seen to
emerge as an aspect of the id devoted to gratifying impulses in a way that
accords with the demands of both outside reality and one s own consci
ence (pan of the superego in Freud s scheme) While the id operated ac
cording to a pleasure principle whereby immediate gratification was its

CHANCING CONCEPTIONS OF MENTAL DISORDER / 13

uppermost concern, the ego depended heavily in its functioning on logic,
reasoning, and a grasp of the workings of the world external to the indi-
vidual. Thus, it often imposed a delay of gratification when acting on the
immediate aims of the id might lead to trouble.

In his book. Character Analysis , Reich wrote of the serious obstacles
that impede the uncovering of unconscious forces. He found in his ana-
lytic practice that, although the first rule of psychoanalysis is that the pa-
tient should associate freely with whatever comes to mind to provide
clues to significant unconscious elements, most patients could not comply
at the outset. Thus a good deal of time in analysis was devoted to over-
coming the resistances that prevented exposure of the unconscious. But
these resistances were not seen to derive from the id itself. Rather, they

were protective mechanisms developed by the ego. Thus the same energy
that the ego devotes to restraining the id and to denying it expression or
access to consciousness was seen by Reich to be used against the analyst s
efforts to expose id forces. Most of Reich's book was devoted to the
problem of dealing with ego resistance.

On the basis of his experience, Reich distinguished between two types
of neuroses: symptom neuroses and character neuroses. The symptom
neurotic suffers the classic symptoms of neurosis whereas in the charac-
ter neurotic the most striking features are certain character traits. Actual-
ly, Reich felt that a neurotic character was present to some degree in all
patients, even in those manifesting classic neurotic symptoms. The neu-
rotic character was described as differing from the symptom neurctic .n
two important ways. First, he lacks insight into Ins condition. Thus, while
the symptom neurotic feels his problem acutely as an uncomfortable a -
ien condition, the character neurotic accepts his difficulties as long-smn A
ing features of his personality. Second, the character neurone can more
readily rationalize his symptoms than the symptom neurotic T he • jper
son may be unhappy about his shyness, but he rarely
mental disorder. Instead, he is apt to view the trait as a
of his P—ality .

p"anobsessio„, or a crippling hysterical symptom can hardly deny

the significance of his disability. . traits os 3 character ar-

Reich referred to these Mngstand. ^ ^ js mccha-

mor, and later Anna Freud ( ) DSVchoIo<Tic3 Hy protective cover-

nisms. Both writers saw these trai P ° defense against outer

ing that people begin to wear ear V in , 1 ^. ^ dnrac ter traits, which
forces, but against inner one . of lhc personality, ame to

had been regarded simply as 1 P“ r d P ^ rcfcrxc d to as character

be recognized as symptoms ot . , 1052. such disorders re-

disorder and later as personality disorder. By

14 / introduction

ceived formal recognition by their inclusion in the American Psychiatric
Association's D.agnosUc and Statical Manual Mental Dwnbji
(Committee on Nomenclature and Statistics of the American Psychiatric
Association 1952) Thus, behaviors such as overdependence, schizoid
withdrawal, excessive orderliness cautious isolation from others, moodi
ness, and hyperactivity came to be considered as reflecting emotional dis
order In addition, this new diagnostic entity encompassed many behavior
disorders such as antisocial behavior sexual deviations, and addictions
which had long been recognized as problems but were regarded as be
longing within the province of legal or religious authorities rather than of
mental health professionals

The new conception of behavioral abnormality represented by the per
sonality disorders has caused another significant broadening of the scope
of the mental health professions The many subtle but chronic types of
behavior viewed as the symptoms of personality disorder are likely to be
present in a large number of people who find their lives unsatisfying be
cause of them Thus the process of periodically redefining and broaden
ing the scope of what is conceived of as behavior disorder has led to a
commitment on the part of the mental health field to a staggeringly high
percentage of the general population — in effect, many times as many in
dividuals as was the case when its domain extended only to psychosis,
ps>choneurosis, and psychosomatic disorders This fact has created many
problems and has played an important role in the recent development of
community psychology as a new, and possibly more effective, way to
deal with overwhelming service needs

CHANGING CONCEPTIONS OF CAUSE AND TREATMENT OF
MENTAL DISORDER

Just as man s conception of what constituted mental disorder has changed
over the >ears, so too has there been a periodic alteration in the concep-
tion of what causes mental disorder, how it is best treated and by whom
To some extent changes with respect to these notions have corresponded
to changes in the idea of what constituted mental disorder, but this has
not always been the case

Man s earliest theory of tfie cause of mental disorder, of course, in
voked supernatural forces Just as primitive man was aware that he could
cause certain events to occur because he willed them, he assumed that
events which were out of his control such as natural phenomena were
caused b> some power higher than himself who willed that these events
should occur With respect to illness in general, primitive man recognized
that some disorders resulted from observable causes and could be treated

CHANCING CONCEPTIONS OF CAUSE AND TREATMENT OF MENTAL DISORDER / 15

directly. A wound, for example, could be cleansed and protected against
further injury until healing took place. Other disorders, however, were
entirely internal, affecting organs that could not be seen in ways that
could be understood. For such disorders, it was assumed that a superna-
tural power was causing this phenomenon, and it was into this class that
most behavior disorders were placed.

When one assumes that mental disorder is caused by supernatural
powers, tlie obvious agent to treat this disorder should be someone adroit
at intervening for man with the gods. In ancient times, such individuals
held different titles in different societies (priests, shamans, witch doc-
tors) , but in all instances their roles were similar. They studied the ways
of the gods and developed and maintained rituals thought to be useful in
placating or mollifying an angry god or in maintaining the good will of a

god who had not yet vented his wrath.

The first change in man’s conception of the etiology of both physical
and mental disorder took place during the classical period of Greek histo-
ry. Up to that time the centers of healing in Greece were the Aesculapean
temples where priests, thought to have inherited the secrets of healing,
tried to cure illnesses with impressive religious ceremonies. Several Greek
thinkers contributed to the change in approach toward understanding the
development of mental disorder, but Hippocrates (460-S37 b.c.) gener-
ally receives the most credit for this change. Hippocrates stubbornly held
that all disorder, physical or emotional, could be explained on he bast
of entirely natural causes. He completely rejected the popular notion that
spiritual forces could cause behavioral disorder. For exampie. in shaking
of epilepsy, which was popularly regarded in his time as a jam dis-
ease Hippocrates wrote: “If you cut open the head, you will find
the brain humid, full of sweat, and smelling badly .And in th y,
may see that it is not a god which injures the body, but .

The rational approach introduced by Hippocrates and other GreeK
thinkers of his time resulted in the establishment ol : «*ooh i « m '

cal practitioners. To be sure the but

operated in a culture that also accepted the teah^role

Hippocrates' approach and " or re P™ and f er accep tance in Eu-
ic modern medicine that recene gr • (he ma : or part of the civi-

rope at that time. As Rome k hysic i ans were imported to

lized world militarily and politically, P extenci< ,d. Hippocrates’

Rome, and the Greek tradition of medicine ^ of theories con-

approach to medicine led to t e d d number of different

cerning the occurrence of " C es "n various forms of physi-

therapeutic approaches, particularly advances

cal therapy. ,„ rn ,d away from rationality in favor of

During the Middle Ages men turned away

16 / introduction

an emphasis on the spiritual. As a result, tlic religious figure as a healer
and spiritual theories ot the etiology of behavior disorder again became
prominent. Superstitious beliefs and magical practices tended to prohlcr-
ate. Unknown and powerful supernatural forces were thought to play a
prominent role in the development ot behavior disorder.

A return to rationality did not begin to take place in a significant way
until the Renaissance, which spanned the 13th, Hth, and 15th centuries.
Threatened by this turning away from orthodox religious practices, the
establishment of the time rigidified its views in many ways that created <
serious hardships for those who were mentally disturbed. The mentally
disabled who were accused of witchcraft and of having formed some type
of invidious alliance with the devil were particular targets of abuse, pun-
ishment, and even physical destruction.

The 17th century brought an increase in the pace of the intellectual
reawakening which had begun during the Renaissance and a resumption
of rational theorizing concerning the etiology of behavior disorders. Nat-
ural causes including various psychological forces were stressed. Philoso-
phers and literary figures played important roles in this change along with
some of the healers of the time. Eventually, these changes culminated in
the work of a number of 19th-century figures who sought to establish a
completely physiological basis for many mental disorders as well as in the
work of Freud and his followers in the late 19th and, particularly, in the
early 20th century, who stressed psychological causes.

Freud's efforts have already been described as causing the first major
revolution within the mental health fields through their scope-broadening
effect. This effect derived from the fact that Freud was concerned pri-
marily with psychoneurotics, a group ordinarily shunned by the mental
health workers of his time. Freud also offered a theory of mental func-
tioning and a theory of personality development that had relevance for all
behavior. As a result, this theory came to be applied to a variety of disor-
ders with which Freud had little or no experience. As a scientist, Freud
himself was routed in the strictly deterministic tradition of the biology of
his time. Furthermore, he was primarily concerned with man as a biologi-
cal entity. In his earliest work Freud attempted to develop a theory of
hysteria based on neurophysiology. When that failed, he shifted to at-
tempting to understand hysteria on psychological grounds. Holt (1965) ,
a scholar of psychoanalytic theory, has questioned whether Freud actual-
ly ever did shift completely, observing that many of Freud's fundamental
psychoanalytic principles are based on assumptions about man's biology
that were commonly held in his day. Brenner (1955) has also observed
that Freud's undying hope was that he could establish the biological basis
of mental phenomena.

In much of his early writing, Freud tended to undervalue man’s expert-

CHANGING CONCEPTIONS OF CAUSE AND TREATMENT OF MENTAL DISORDER / 17

ences as a social being and not uncommonly referred to external circum

stances as "accidental factors ’ This implied that the only regularity m
man’s experience was what occurred within his body and that external
forces were so irregulaF as to be unsuited for scientific study For Freud
the forces that moved man, that prompted behavior, were always internal
ones The few social regularities of which Freud s early theories took cog
nizance were thought to have arisen as the result of the inheritance of ac
quired characteristics Thus the transmission of cultural practices was
thought to have become part of mans internal genetic structure rather
than being derived from external environmental factors

Freud’s thinking tended to stimulate m others considerable theorizing
regarding mental functioning and a number of theories appeared during
the first half of the 20th century to explain the development of behavior
disorder as well as man's personality in general Some were advanced by
students of Freud, and in many instances these theories deemphasized the
biological factors stressing, instead, the significance of social forces
Theorists like Alfred Adler, Erich Fromm, and Karen Horney empha

sized the regularity of certain of man’s social experiences and the effect
that they can have on development The writings of these theorists culmi
nated in the advancement of a social psychological theory by the Amen
can psychiatrist Harry Stack Sullivan that was perhaps as elaborate as
Freud s own In his writings Sullivan regarded man s social experiences
as being the most significant forces in shaping his personality He went so
far as to insist that even physiological functions are shaped by man s in
terpersonal experiences in that the organism acquires socialized ways of
breathing eating digesting and eliminating

Another significant modification in psychoanalytic theory resulted
from the work of the group of psychoanalysts who b f ca ” e kn “™ 35
"ego psychologists These men became well known in the 1930s thr g
their reformulation of some of Freud’s theories regardmg the < ego. As de
scribed earlier in this chapter the writings of Wilhelm Reich w “‘| n A "
Freud had highlighted the importance of ego function S P

choanal ytic practice Reich and Anna Freud, however empha ired the
ego’s defensive role Theorists like Heinz Hartmann and fr.er RudoU
Kris, Ernst Lowenste.n David Rapaport, and Enk Enkson had much
say about the ego s positive side its adaptive capacity wlth

These theorists regard the ego as - imle^nd^
energy sources of its own and a n J ^ P thcorIC , assumed that
ly of its role as a gratifier of the id necessity for having an

the ego s existence was entirely ase maximize gratification for

agency equipped to deal with outer rea i i between the individual

the id and to rn,,, unite the development of conflict utlllK
and outside forces To further h,s aims this agency

18 / introduction

mans cognitive and sensory apparatus Presumably, therefore, man de
veloped his sensory and perceptual capacities, exercised his imagination,
Sharpened Ins memory and manifested his curiosity solely because these
qualities enabled the ego to do its job for the id more effectively It was
this notion that was disputed by the ego psychologists
Hartmann (1958) felt that the exercise of perceptual and cognitive
skills was gratifying in and of itself There is a joy in learning about the
■^Mid-in developing inner potentialities of all kinds This observation
prompted Hartmann to theorize that the ego or the potential for an ego,
exists within the newborn infant and will be developed regardless of the
demands of the id Freud s relatively narrow view of the ego was thought
to have developed mainly because early psychoanalytic theorists were at
tempting to deal with psychopathology With the broader view that the
ego functioned in conflict free spheres it became possible to begin a
study of positive aspects of human behavior such as the process of adap-
tation Hartmann emphasized the need to know how one s abilities and
character related to his adaptive capacity a largely neglected area within
psychology Other theorists notably Erikson (1950) , have attempted to
describe the process by which mans ego adapts to the varying social
forces which act on him from birth onward
The work of the recent theorists who have emphasized social factors in
man s development as well as that of the ego psychologists have provided
a theoretical underpinning for the community psychology movement The
social theorists work has led to a concern for the nature of the forces to
which man must adapt and toward some thinking about how these forces
might be altered to ease man s adjustment The thinking of the ego psy
chologist has led to the idea that a personality can be strengthened as it
develops to be better able to withstand the life stresses that must inevita
bly be faced Thus mental disorder can be prevented and the necessity for
treatment eliminated Turner and Cumming (1967) have pointed out
that personality growth within the framework of ego psychologists for
example Erikson results from the resolution of developmental crises
(the problems to which all are exposed m their growth through various
periods of life such as childhood adolescence adulthood middle age
etc) The successful resolution of a particular crisis provides the mdividu
al with a new set of skills that can be used to meet later crises This be
mgn cycle can build a strong personality well suited to weathering future
stresses People like Lindemann (1944) and Caplan (1964) have ex
tended this idea and regard nonnonnative crises (such as bereavement
accidents and divorce) as opportunities for personal growth if they are
dealt with successfully Thus it is asserted that mans unhappiest and
most stressful experiences can be capitalized on to enhance personality
development and to render the individual less vulnerable to future stress

THE MEDICAL MODEL / 19

The idea of capitalizing on crisis as a means of building strength, as
well as of reordering social forces to render them less stressful and more
growth enhancing presumes an active, intervening, “busybody” role for
the mental health professional Such a role is drastically different from
the traditional one For this reason many community psychologists ques
tion traditional roles and the service model on which these roles have
been based, the so-called “medical model ”

THE MEDICAL MODEL

A number of writers have referred to the medical model without defining
it Several have defined it but in different ways Therefore, one is again
confronted by a semantic morass needing ordering and clarification

First, any model serves as an exemplar for guiding others In the men
tal health field models can provide a fundamental set of assumptions with
which one approaches data and which both guide observations and deter
mine how these observations will be grouped and evaluated Models can
also define the “turf” on which people will interact and set limits on the
possible operations the professional might engage in Thus models, as
guides to professional thinking and practice, have a number of character
istics and implications To speak of a medical model without specifying
how it is being defined or without describing the aspect of the model to
which one is referring can only be confusing

Brown and Long (1968) have reviewed the recent community psy
chology literature that refers to the ' medical model and have attempted
to describe the trends they find m the various meanings applied to the
term They point out that the notion of a medical mode is frequently as
sociated with issues such as the realities of power, t le press o
power needs and resources," and "the pressure of increasing puhl. de
maud for mental health services • These authors ^
term as a confusing composite of several "theoretical and operational

^Essentially Brown and Long believe that the term has been used tluee
different ways First, the medical model has been m invading

ease concept of illness that >nvolv a" m thf
bactena and the like in which di P ^ {hls approac h has been
case of physical illness Brown an g emphasize ps>choIogicaI

unjustifiably contrasted w-h other mmfelsrt « ■ tw0 ap
etiology of behavioral dysfuncuo , n Sarason and Ganzer

proaches cannot be viewed as P „ OTtlc , sm of an overly

(1968) have also taken issue with what t y that „j iat

literal interpretation of the illness model These authors gu

20 j introduction

has been borrowed by psychology from medicine is not the notion of
physical pathology but merely some assumptions about underlying causes
and some terminology. Like Brown and Long, Sarason and Ganzer view
the attack on the illness or disease aspect of the medical model as a spe*
cious one stemming largely from an interprofessional rivalry and the
chafing of psychologists under an established professional structure which
has the physician at the top.

The other two ways in which Brown and Long find the medical model
being used are also related to power issues. In one case, these authors
feel the term describes the way in which mental health services are organ-
ized and administered, with a physician or psychiatrist inevitably serving
as director and other professionals being ancillary members of the service
team. Finally, Brown and Long believe that the medical model is often
used to refer to the formal or "establishment” structures that have grown
up in the mental health fields around the ways in which diagnostic and
treatment services are rendered. Thus some settings may be run in such a
way as to exclude psychologists and others may exclude psychiatrists.
Both established forms resist change, and Brown and Long feel that to al-
ter their form would require not only an attitude change but also a
change m the entire social system.

Although interprofessional power struggles no doubt have played a
role in die concern expressed by community psychologists about the med-
ical model, it would be an oversimplification to assume that such issues
account for all these expressions. Turner and Camming (1967) point

mentaTandT ' '^u* C ° r ° Uary ° f the ana]o SV *at is drawn between
”r D atient reW V T u ' he retcntion ° f th « typical one-to-one doc
acdve one on Iv w’ P ln ‘ hls , relationsh! P the patient’s role is seen as an
in the doctor’s offi° h* * takeS ,Ile Im 'i a tive in seeking help; but once
mi^stemd m The n . m , es ' h ' ? a5sive ’ sick “Mdil waiting to be

dent to seek him outsat which ttoe 17 a "IT Wai ' Pa f VdV £ ° r ‘ he pi “
t; ve e can become authoritative and ac-

medicaI mo ' W ' bolh B,oom < 1965 > and
edge the centrality to the tbey also acknowl -

sive-receptive authority and a ’’sick" individ^ , ' omh, P between a pas-
brought to him. Both the disease aspect and the Wh ° h ‘ m ° Ut ° r “
medical model have been called into question PaSSWe ° r,en ' at!on ot the

The illness or disease model, whether taken literallv ™. c • , ■

h°eahh er ; d 10 be r leading and "» damaging 6 n .h: gUrat,Ve,y> “
health. For examole. /iqga\ 6 . c '

l For exam nip TlpJff /iocc\ ~ in tn « area of mental

to,.™. ,m

THE MEDICAL MODEL / 21

tions The working class, therefore, has difficulty accepting the idea that
lesser behavioral problems can fall within the province of the professional
who deals with mental illness Thus, severe mental disturbance is viewed
as an illness to be treated by some kind of doctor while less severe emo-
tional disturbances are attributed to undue environmental pressures or
moral weakness which should be dealt with by one’s minister or mastered
through self control Attitudes of this kind pose obvious challenges for a
community mental health approach
The validity and utility of the disease model has also been criticized re
cently by practitioners, notably Szasz (1960) , who are not identified with
community psychology or community psychiatry movements Szasz feels
that in work with individual patients the notion of mental illness or dis
ease is both misleading and damaging Illness is seen as deviation from
some norm Since ideal physical health can be described by physiological
and anatomical indexes, physical illness can be readily recognized as a
deviation from this ideal Assessment of mental illness, however, is not so

straightforward The norms from which the mentally ill deviate are ps>
chosocial, ethical, and legal ones Adherence to a disease model commits
the mental health profession to seeking medical remedies, presumably
free of ethical values Thus a basic contradiction exists between the way
the behavioral disorder is defined and the way we attempt to alleviate it
This, Szasz believes, has serious detrimental consequences It allows peo-
ple to avoid facing their problems, since they can blame their failures on

their mental illness

Szasz’ position may be criticized on the grounds that one of his major
objections to the medical model is based on his discomfort with the carp
mg over of medical terminology into the mental health field Thus for
example, ‘'etiology” is used instead of cause, and symptom is u
instead of "sign” Th.s, however, does not necessaniy imply that pracn
..oners regard behavior d.sorder as analogous to physical
ters attend baseball and basketball clinics, an some B 3
nose" mechanical problems in their automobile dimes, and no one
gards such settings as medical m any nay Srasr not, Id p obrbly coon*
Sis critique by afgu.ng that many medically «*«•»«“?£ “'1*° *
ers are. in fact, committed to ^“'^'^'“^Ira^.t^a fmm many
ances Furthermore, m an effort to rem . a j., n to pW,

disorders they hate been popularly cliaractcni . ps)C i, 0 !ogical

cal disease As a result, even if the ^

causation, the patient is predispose P . , t | lcn j 1( . KOC5 t0 a

health practitioner in the same passive spi

medical practitioner _„.,i health professional b)

The passive orientation imposed “ ££ T ’ tarn bn role to .ha,
the medical model has its own serious drawback

22 / introduction

of a “counterpuncher" with respect to behavioral disorder. « one holds
literally to the notion, as many in community psychiatry seem to do, that
one's exclusive function is to attend those troubled mdtv.dt.als who seek
you out, the practitioner is in the position of only being able to react aft
a problem has emerged. In a world where therapeut.c efforts would .al-
ways be successful and where professionals could be trained in numbers
sufficient to treat all who needed their attention, there might be little need
for a service delivery approach other than the one dictated by the medi-
cal model. As we point out in the next chapter, neither of these situations
pertain in the current mental health scene.

Thus, for the community psychologist and, indeed, the community psy-
chiatrist who wishes to mount preventive programs, operating within the
limits imposed by the medical model is detrimental. The disease aspect of
the model, whether taken literally or figuratively, predisposes people who
might receive mental health services to attitudes that interfere with their
being able to use such services optimally. This is acknowledged by some
professionals who use very traditional treatment approaches as well as by
community psychologists. The passive role imposed on the professional
by the model would tie his hands with respect to taking active steps to
head off the development of behavior disorder even when many of the
conditions for producing it can be identified.

Many might contend, with respect to the latter point, that the medical
model contains within it a model of service that is devoted to the preven-
tion of illness. This is the model followed by the public health physician
who has been concerned with eliminating the source of diseases and with
widespread programs of inoculation against disease. Medicine’s success
against disorders like typhoid and smallpox are products of public health
medicine.

Unfortunately, until very recent times, the public health model in med-
icine has had little impact on the mental health professions. As early as
1908 Adolph Meyer (Lief, 1948) argued for the necessity of “aftercare”
the preparation for family and community to receive the discharged
hospital patient, and follow-up efforts to prevent recurrence of mental
disturbance in the recovered patient. Meyer believed that efforts made to
prevent recurrence of mental disorder would lead naturally to an under-
standing of how to prevent mental disorder in the first place. Brand
(1968) points out that social work began to develop in the early 1900s
as a profession devoted to playing the kind of community role that Meyer
envisioned in the aftercare movement. Despite these early stirrings of a
?n*r n ^ Ve ap P roach> little Progress was made in this direction until the
1960s. The reason is that while a public health model was being champi-
oned in the mental health field, another much more exciting movement
was developing. The psychodynamic discoveries of Freud were beginning

CONCLUSION / 23

to become well known and popular, particularly in the United States, and
they were applied within the aspect of the medical model (even eventu
ally, by social workers) that involved a healer-expert who waited for po-
tential patients to come to him Thus the public health model receded m
significance among the mental health professions for several decades
In addition to the fact that the public health aspect of the medical
model has had little impact on the mental health field it is necessary to
point out that there are some fundamental differences between how the
public health or preventive approach can be applied in medicine an m
mental health These differences arise from the attitudes hel y g
oral public toward physical disease and mental disorder Mo« Pe°ple
needhttle convincing that they are vulnerable ,o small pox typhoid fe
ver, and hepatitis and wilhngly cMj*^ an acknowl

oculation or improved sanitation On t f stl ti

edge their vulnerability ' to school failure,

SLEtTiT ".a'rr* ,

factors Thus to mount P^nd'o'f ag^ss.veness that is perhaps more
sional must have a special kma o g g , rp f ormer than it is of

characteristic of the crusading P° '"™' 0 °p ltaI prac t.ce remote from the
one reared in the traditions of off me P dlc al model holds out a serv

community arena In essence w * ^ fcw alteratlo ns by mental

ice delivery example that can be : P medicine requires many

health professionals the public health field

modifications before it can be applied in the mcnl

CONCLUSION „ . ,i ea i

Community psychology , » ** »

viro^meiit U iir caiistng^djmtment pri^lemr^hi^approacl^re

late environmental forces to f llev,a “ a f ve inte rsent.on.st instead of
quires the mental health worker to be an a

wait passively for problems to come to mm about what mental

A review is made of the ™ imo lvmg periodic redefinition

disorder is and what causes it-a F pro gress.sely broadened li e

of behavioral abnormality and one tha 1 PJ^j 5 ,„cc .he 1 e
scope of the field Many such redefin 1 “°" (ncn , en t known as eommun -
19th century and have cuIm,nat ? ia , ".molted the recogn.l.on of beba'mr
psychology These redefinitions emotional and P»>cho^

F greater and greater " “ E ," !i psychology mm areas formerly
leal causes and has extended tl.e sp

24 f introduction

considered relevant to other fields such as the law, the church, and cduca
tion The most recent redefinitions in the scope of the mental health field
have led to a concern for the effects of social forces on psychological de-
velopment and adjustment, and to a belief that in the process of growth
the personality can be strengthened to withstand stresses
Some consideration is given to the fact that traditional mental health
role models fail to serve the community psychologist The medical model,
a service model from which traditional role models derive, is discussed
and compared to the public health model, which better suits emerging
professional roles

THE ORGANIZATION OF THIS BOOK

This book is written in three parts The first is concerned with definitions
and establishing a historical and theoretical foundation for community
psychology It consists of the present chapter and the one that follows
The second is by far the most extensive and is devoted to descriptions of
a variety of specific community psychology programs Each program is
d^cussed with reference to the type of problem with which it attempts to
deal The final section discusses the many problems faced in these emerg
ing programs and the future prospects of the field

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Psychologist , 1965, 20, 832-835 Umt Y raenta l health American

Bennett, C C , Anderson, L S . Coonpr c « , , ,

G (Eds) Community psyrtwlopv ' ^ * ^ asso1, ^ * Klein, D C , & Rosenblum,
education of psychologists for ^ ° T€ P° rt °? the Bost on conference on the
University lil ,9M ' mcnM health ^ Boston

Bern cemer v, t v [ m a

BtaT rr T “°T N r, York

healdi = ^d-nmun.ty menial

REFERENCES ( 25

Brand, Jeanne L The United States a historical perspective In R H Williams
& Lucy D Ozann (Eds), Community mental health an international
perspective San Francisco Jossey Bass, Inc, 1968, Pp 18-43
Brenner, C An elementary textbook of psychoanalysis Garden City, N Y
Doubleday Anchor Books, 1955

Brown, B S , & Long, S F Psychology and community mental health the
medical muddle American Psychologist, 1968, 23, 335-341

Caplan, G Principles of preventive psychiatry New York Basic Books, 1964
Caplan, G Community psychiatry— introduction and overview In S E Goldston
(Ed), Concepts of community psychiatry a framework for training
Bethesda, Md US Department of Health Education, and Welfare, Public
Health Service Publication No 1319, 1965 Pp 3-18
Committee on Nomenclature and Statistics of the American Psjchiatnc
Association Disgnostic and statistical manual-mental disorders Washington,

D C American Psychiatric Association, 1952
Cowen, E L Emergent approaches to mental health problems an overview and
directions for future work In E L Cowen, E A Gardner, 8. M Zax (Eds),
Emergent approaches to mental health problems New York. Appleton Cen
tury Crofts 1967 Pp 389-455

Cowen, E L , Gardner, E A , and Zax, M Emergent approaches to mental health
problems New York Appleton Century Crofts, 1967
Duhl, L J The psychiatric evolution In S E Goldston (Ed ) , Concept,
community psychiatry a framework for training Bethesda, Md U S
Department of Health, Educa.ton, and Welfare, Publtc Health Serv.ce
Publication No 1319. 1965 Fp 19-32

Dunham, H W Cotnmun.ty psych.atry .he newest therapeu.tc bandnagon
Archives of General Psychiatry, 1965, 12, 303-313
Ertkson, E H Childhood and society New York Norton, 1950
Freud, Anna The ego and the mechanisms o, defense London The Hogarth

Gelfa P nTs 9 l 7 Kelly, J G The psychologts. m ti,m jnu, J^nta. Health

Scent, st and profess.onal „ tI thc Commttnt.y the

Golann, S E, *. Etsdorfer C ,, c Elsl lorfcr, Handbook of

development of issues In S Appleton Century Crofts. 1972 Tp

Community Mental Health New fork A P P'«°

3-17 , hnrhiatn a frameuork for training

Goldston, S E Concepts of romtmmilypty ^ ua „ 0 n, and Helfare. 1'ubl.c
Bethesda, Md U S Department of Health, to

Health Serv.ce Pt, bl.cn, ton No 1W, U ™„„om In I- M

Halleck, S L Community psyc.ua, o ^ p 0 ch,a,ry Ganlen

Roberts, S L Halleck. k M B hocu !•

Cy.N Y Doubleday. 1969 Pp ■ »- „ aiafUM n New W>,k

Hartmann, H Ego psychology and P
International Unts entiles Tress, tone

26 / introduction

Hersch, C From mental health to social action clinical psychology in historical
perspective American Psychologist, 1969, 24, 909-916

Holt, R R A review of some of Freud's biological assumptions and their
influences on his theories In N S Greenfield, and W C Lewis (Eds ) ,
Psychoanalysis and current biologtcal thought Madison* University of
Wisconsin Press, 1965, pp 93-124

Hume, P D Principles and practices of community psychiatry the role and
training of the specialist in community psychiatry In L Beliak (Ed ) ,
Handbook of community psychiatry and community mental health New
York Grune & Stratton, 1964 Pp 65-81

Joint Commission on Mental Illness and Health Action for Mental Health New
York Basic Books, 1961

Jones E The life and work of Sigmund Freud, Vol I New York* Basic Books,
1953

Jones, M R , & Levine, D Graduate training for community clinical psychology
American Psychologist, 1963, 18, 219-223

Kahn, A J Planning and practice perspectives on the boundaries of community
psychiatry In L M Roberts, S L Halleck, and M B Loeb (Eds),
Community psychiatry. Garden City, N Y Doubleday, 1969 Pp 173-191
Lief, A (Ed) The commonsense psychiatry of Dr Adolph Meyer New York
McGraw Hill, 1948

Lindemann E Symptomatology and management of acute grief American
Journal of Psychiatry, 1944 101, 141-148

Loeb M B Community psychiatry what it is and what it is not In L M
Roberts S L Halleck and M B Loeb (Eds ) , Community Psychtatry
Garden City N Y Doubleday and Co , 1969 Pp 235-250
Mechanic D Community psychiatry some sociological perspectives and
implications In L M Roberts S L Halleck, and M B Loeb (Eds),
Community psychiatry, Carden City, N Y Doubleday, 1969 Pp 211-234
Retch, W Character analysis, 3rd Ed Net, York The Noonday Press, 1949
a " d

ptobkm ot A —

Sabshtn M Theoretical models m comtnumty and soctal psychtatry In L M

Gariencftv NV n m", B L ° eb < Eds ) . Common, ty psych, a, ^
warden City, N Y Doubleday, 1969 Pp 13-30 ^

“SurC® and ' h ' m ' n ‘ al h “ ]th m ° Vement Amc ™” Psychologist,
Sm Ts,2 °— « “ -del .merman

Stole, L. Selected sociological perspectives In S E Goldston (Ed 1 Conceits of
community prychiatm, a framework for teaming Bethesda.’ Md U S

REFERENCES / 27

Department of Health, Education, and Welfare, Public Health Service
Publication No 1319, 1965 Pp 33-46

Szasz, T S The myth of mental illness American Psychologist, I960, 15, 113-118
Turner, R J , & Gumming, J Theoretical malaise and community mental health
In E L Cowen, E A Gardner, and M Zax (Eds ) , Emergent approaches to
mental health problems New York Appleton Century Crofts, 1967 Pp
40-h2

Zax, M , and Cowen, E L Abnormal psychology changing conceptions New
York Holt, Rinehart and Winston, 1972
Zilboorg, G , and Henry, G W A history of medical psychology New York W
W Norton 1 Co, 1941

- 2 - recent impetus for
community approaches

irun to em* er t£le ^ uestlon wb y community psychology has be

^ The preceding chapter pro

the rmnim,,, , ” eld ot ab normal psychology out o£ which

uTrirrr 15 have , grown n is ^

opmem ofLXones^d"!: 1 " eaUh ^ ““ acc ™"“ d £or thc dCTeI

Moreover commnmrv u \ ° me extent * new treatment approaches
- s “-toed to have resulted from the
n.tion cle abot ^ ^ health fidd why has this deli

new movement takmgdll £££ "* *** “ tb ' 5

o£ — nity

like a senes of disconnected events and circumstances have,

28

RECENT DISSATISFACTION WITH TRADITIONAL FUNCTIONS / 29

'"RECENT dissatisfaction with traditional

FUNCTIONS

Psychoanalysis and psychoanalytic psychotherapy enjoyed widespread
acceptance in the United States from the time of their introduction in the
early 1900s (Shakow and Rapaport, 1964) The new treatment ap-
proach seemed to hold promise for effectively alleviating psychopatholo-
gy Professionals were eager to learn these techniques, which soon became
basic to the armamentarium of the mental health worker Psychoanal
ysisled to exciting discoveries about the way people function psy
chologic ally a nd, above all, seemed to offer the hope that man’s psycho-
logical problems could be dealt with effectively

"Although other psychotherapeutic techniques based on t >’ eor <; tl ‘; a
principles at variance with those of psychoanalysis were introduced be
tween the early 1900s and 1950 most mental health workers leaned to
accept the basic notion that psychotherapy would solve our mentalheahh
problems In 1952, however, the blind faith of Preceding »
was profoundly shaken by a paper by Eysenck which attacked tte suR
posed effectiveness of psychotherapy Eysenck 1

studies reporting on improvement rates as the resuU t wo

, r . c t_T| ~ oz-npral conclusions were that rougniy u

therapeutic approaches His general ' c o{ hotherapy

thirds of all patients improve, regardless of such results could

undergone Eysenck reasoned lhjt ‘ rates aroon g patients

only be determined by «’ ra P ar '"S a J led by psychotherapists but un
suffering problems similar to tho found two studies m the litera

dergomg other methods of trea “ Qne orted on severe neurotics
ture referring to such , pauent g P y » ^ P hospltaI system between
who had been treated in the N percent of the patients were

1917 and 1934 In this group roug ^ 7 Another baseline es

rated by their physicians as improve ftaJ rovl ded in a study of

timate of improvement without psy nsychoneuroses to an insur

500 individuals making disability cbl ” E’ from the files of a single
ance company These cases * a ^"""te country represented all
insurance company, were from a P t, een ^ for at least three

types of psychoneurosis, and al a,r “ g cic h claimant was totally
months before the claims were submitted l ^ ^ ^ erc A1 i 0 f these pa

disabled, the psycho neurosis

Tcv-Is, tlV

disabled, the psychoneurosis could be c aj|S an(1 * C re treated w

tients were seen regularly by t reir ° J P ssurancCi suggestion and w un
drugs of vinous kinds, is wel as » mlght base available but not

ever stock the ordinary general pric „ cr e followed up for =

with traditional psychotherapy All rf as ten years after the

period of it least five years and some

30 / recent impetus for community approaches

disability period had begun Using the ability to return to work and to ad
just adequately economically as recovery criteria, it was found that 45
percent of the patients recovered after one year and another 27 percent
recovered after two years, making a total of 72 percent in all Comparing
the results of many studies of psychotherapy outcome with those of the
two baseline studies of New York State hospital patients and of the insur
ance claimants, Eysenck concluded that psychotherapeutic treatment pro-
duced no better results than ordinary hospital care or the attenti on a
general practitioner Thus psychotherapy was not demonstrated to be su-
perior to other more superficial approaches
Furthermore, Eysenck compared studies evaluating the effects of
long term psychotherapy, such as psychoanalysis, to those involving more
superficial therapeutic approaches He found that, on the average, about
44 percent of those patients having long term, intensive therapy im
proved, whereas 64 percent of those patients treated more eclectically
and less intensively improved Neither of these figures quite reached the
improvement rate of 72 percent that was found with insurance claimants
treated by general practitioners Thus Eysenck’s figures indicate an in
verse correlation between recovery and psychotherapy, the more inten-
sive the psychotherapy, the lower the recovery rate

Eysenck (1952) has summarized the import of his data as follows

“7n general, certain conclusions are possible from these data They fail
to prove that psychotherapy, Freudian or otherwise, facilitates the recov
ery of neurotic patients They show that roughly two thirds of a group of
neurotic patients will recover or improve to a marked extent within about
two years of the onset of their illness, whether they are treated by means
of psychotherapy or not This figure appears to be remarkably stable
l ™ esi W*°n to another, regardless of type of patient treated,

St Znt ni ° f re 77 empl0yed > ° r ™ th °d of therapy used From the
point of view of the neurotic, these figures are encouraging, from the

S'* :zi^T rap,st ’ they can hardly beJ,J ***

s.onaTswhn n ^ P T “ m,derabte react.cn from other profes
Wertheimer T 9 54 '7 many ° f ^ asser "° n < De Charms, I*v£ and
1956. (pn I954 ' Cart '™s'«, 1955, 1956, Btndra,

1956) Some denied the equivalence of the outcome criteria in the exoer
imental and control studies cited by Eysenck others i u

contention »w r n . \ Eysenck others took issue with the

t-onienuon that the so called control eroun did not ,

nv Still n»Wc i a u i 5 IOU P mu not receive psychothera

py aim others attacked the logic of Evsenrfc mnri,, 1 ,
extent the hoTri»v i . Eysenck s conclusions and to some

r7e p rc y '^rr : F z h

able to disprove Eysenck’s fundSH^STWclusion that

WCENT 0!«\T!SFACT10.V WITH TRADITIONAL FUNCTIONS / 31

convincing demonstrations of psychotherapy's effectiveness had yet to be
offered. In fact, Eysenck’s critique fins been revised and updated since
1952 by Levitt (1957), who extended the survey to the outcome of work
with children and by Eysenck himself (19G1) .

What seemed to be heresy at the time of Eysenck’s paper has become
fairly well accepted as fact in recent years. For example, Schofield
(196*1) was willing to state in the mid-1960s that . . we are still
awaiting definitive research — we still do not have acceptable evidence
that psychotherapy accomplishes significant reduction of neurotic symp-
tomatology, let alone evidence that the several different forms of psy-^
chothcrapy have different levels of efficacy” (p. 99) . Thus the tendency/
to doubt the effectiveness of psychotherapy l>ccamc fairly common after
Eysenck’s critique appeared. Furthermore, many in the mental health
field began to express the thought that even if psychotherapy is effective,
it is not a practical answer to the large-scale mental health problems of
today’s society. For example, Eisenberg (1962) has stated:

" The limitations of present there peutic methods doom us to training
caretakers at a rate that ever lags behind the growing legions of the til ,
unless we strike out successfully in new directions in the search for cause
and treatment . . . Society can ill afford today’s precious oversea,
alization in which trainees may learn one method even superbly well but
a method that ever lags behind the demands placed upon it while they
remain abysmally unaware of the problems besetting t e u of
tally ill " (p. 825).

From the foregoing, it is evident that there are many within the . mental

health fleld who question the overall efficacy of F^^dence feel
tion, others who, even in the absence of hard “penmen al ™

that psychotherapy is effective, nonetheless feel that
not meet society’s overwhelming men hothef apy ’ s effectiveness, many

the position taken on the issue of p> P with our widespread

professionals are calling for new ^ (he e | cc tiveness of psychoth-

mental health problems. Those who f Those who retain

crapy prefer wfde-sca.e community ^evemive^e Forts. ^ ap

faith in the utility of psychotherapy non professionaIs in pro-

proach more widely available throng fo])owing chapter. Despite the

grams like those to be described in overa „ effect j v eness of psycho-
failure of research efforts to docum us ; n g some psychothera-

therapy, there may well be const era e an( j problems. It would,

peutic approaches with some types o p a( psyc hotherapy in the

therefore, seem premature to a an on ition ; s supported by

absence of a well established a terna ■ j j a£ter Eysenck’s ong-
the fact that behavior therapy, which was deve pe

32 / recent impetus for community approaches

inal critique offers very encouraging results in dealing with certain types
of behavior problems Thus it does not seem unreasonable that some
community psychologists are turning away from psychotherapy while oth
ers are training nonprofessionals to engage in the practice

The leaders of the mental health professions who participated as mem
bers of the distinguished commission established by President Eisenhower
represented another major source of criticism and dissatisfaction with tra
ditional approaches This group known as the Joint Commission (J oint
Commission on Mental Illness and Health, 1961) , was an interdiscipli
nary body established by the Mental Health Study Act of 1955 and was
selected by the National Institute of Mental Health to evaluate the mental
health needs of the nation and to recommend steps for meeting such
needs The opening statement of the Joint Commission report is as fol
lows

' We are tempted simply to take the position that there is a crying pub
he demand and needs are easily observable in the difficulty many persons
experience tn seeking a psychiatrist when they feel the need of one, tn the
long waiting lists of mental health clinics, the small amount of treatment
many clinic pattents receive, the total absence of mental health workers
and chntcs in many communities, the overcrowding of public mental hos
pitals, and their professional staff shortages (p 3)

This report is particularly critical of the state mental hosp ital system s
which it describes as largely custodial and ’punitive and'whose very na
ture and existence are attributed to society s longstanding tendency to
reject its mentally ill a problem alluded to in the preceding chapter that
has typified the attitudes of much earlier times

Other critiques of the hospital system appeared in the 1950s most nota
bly that offered by Goffman (1961) He maintains that not only are
many basic hospital practices employed primarily for the convenience of
the staff rather than for the therapeutic benefit of the patient but that
many such practices are actually anti therapeutic
Another source of dissatisfaction with traditional mental health_ptac
of memalT bn ' ant ‘"'T' 1 " that _exmw ! th_re_spect to the. delivery
nar, S T'— J °‘ m Commi5s ‘°" repoTT^s out tins
poru a e *' SpeCt “ Sta " men,al hos P“ al *£em That re

ZlZ,r lT T, n ,a J pTOblem °< Care °f the M, we find

Wme ‘ he ^ta g e Mice

- m ta Z T, r P T m ‘ h ma, ° r mental llln ™ — concentrated

th' Uv J jTh , m r ablc resuit n that thme ^ mth

least available money have the fewest psychiatrists, and the average

RECENT DISSATISFACTION WITH TRADITIONAL FUNCTIONS / 33

State hospital continues to occupy its historic position in the forgotten
corner of medicine ” (p. 146).

Several large-scale surveys have also made it clear that traditional
mental health services are distributed in a grossly inequitable way. Holl-
ingshead and Redlich (1952) did a survey of mental patients in New Ha-
ven, Connecticut in which they hoped to answer two questions: (a) Js
mentaLillness related to social class? (b) Does a mentally ill patient’s po-
sition in t he status system affect how he is treated for his illness? They
found witiTrespecf to neurotic disorders that there is an inverse relation-
ship between social class and the number treated in public agencies; that
is, t he lower the so cial class the greater the proportion of patients seen in
public agencies instead of by private practitioners. This is explained read-
ily Sy^theKctthat^ the lower classes can ill-afford to pay the fees of pri-
vate therap istsTOnlthe other hand, the nature of the treatment received is
also linked to social class. While individual psychotherapy is the predom-
inant treatment mode in all classes, those in the lower classes are more
likely than the higher classes to receive directive psychotherapy, shock
treatment, lobotoray, or drug treatment. This difference pertains even
within individual agencies. Also private practitioners tend to administer
intensive'arfalytic psychotherapy to members of higher social classes^ and
tCT^more dire ctive therapies to the lower daises. Furthermore,
'within agencies the frequency with which the patient is seenjs ^o reht.
ed to social classTwith the higher classes being seen more frequently and
forlonger'periods oftime_than.the lower classes. __ mvchotic

Holhngstmad and Redlich found similar
patients where, holding diagnoses con > received Among

Found between social class and

schizophrenics, for example, those S soc ial claBe ,

likely to receive psychotherapy whereas those of the lov

are most likely to receive custodial care. u-Hlirh were reported in

Results similar to those of HoUingshead and Re^w^ p ^

a survey done in midtown Manh ’““ ass( ,; s the prevalence of mental
and Rennie, 1962) . In this study York c ; ty> nearly 2000 resi-

disturbance within a discrete area o ents we re made of their

dents were interviewed intensive y, a survey was informa-

mental condition. Among the data collected in

tion indicating whether an individual was a p ^j^conomic status
found that those h.gn i para .

i the local mental

health facilities It was
were more likely to receive

treatment than

those of lower status, t

doxically, itwasjdso found thatjnental ;” pa, ™y hest income ..levels

WstLd~ni<ufeL.andJqlv

ThereforeTThelocial class receiving

was highest in the
income, .level?,
mental health

34 / recent impetus for community approaches

agencies displayed' the lowest rates of severely impaired subjects in the
study. Despite their greater need, members of the low socioeconomic
classes in New York City receive less attention from mental health pro-

fessionals than do the higher classes.

Sanua (1966) has surveyed a number of studies that provide evidence
of a relationship between sociocultural factors and the type of treatment
received by mental patients. He found that lower class patients are less
likely than those of the upper classes to enter psychotherapy, arc less
likely to remain in psychotherapy, and are more likely to leave treatment
after a few interviews. The primary treatment that they are most likely to
receive is some form of symptomatic therapy. Sanua’s survey indicates

that traditional approaches to mental health problems are not appropriate
for the lower social classes, and that our system for delivering these serv-
ices tends to consign members of the lower classes to the most superficial
approaches. This trend may well be related to the tendency, as reported
by Hollingshead and Redlich, for mental health workers to diagnose schi-
zophrenia more readily among the lower social classes than among the
higher classes. A diagnosis of this kind is prognostically pessimistic, and
it is conceivable that once the patient is stigmatized by such a label, he
tends to be abandoned to the less dynamic, custodial treatments.

Some might argue that the inequity in mental health services delivery
is simply part and parcel of the inequity in the delivery of health services
m general. From this view the aims of the community mental health
movement may be considered as identical to those of the public health
movement, providing more services so that the lower social classes will
be neglected. This analogy, however, is an oversimplification,
out o/etn * praCtl . t ! oners use trea tment approaches that have grown
are accustomed? memberS °' advama S ed ‘°cial classes, and they
classes AsTre, l°, t' 1 " 8 - ° r pr ° b,em5 W^lly f°™d !n these

(1973) indicates, tradi-

cZtZTLnT praCtU,oners " tu ™ off" members of the lower social
t medkaTpmc it L" “‘“‘T ^ P^ological treatment. Whereas
metiers if he can l PP ' y Z ,Iaditi °nal tools to low social class

many changes if he is to be effeclive '"rTrlarn'T' T?" mUSt make
that when the v • , * 0r exam P le . Lonon points out

or be,ter^„Trse S : £ y I g r*Tlr; ‘, he °~ is as good as
the mental health worker should not automLfr l't™ t SUggeS,S
py as a treatment approach wil ,h e Cl , 7 ' ° U ‘ ^othera-

yond such attitude change, however the me nu I ?*“ occurs ' B<>
called on to develon a new storl- ,’t e " tal health worker is also

low socioeconomi^ patients ' T t *?***, “ “7«“

classes. h ° P °* P "* I “ *“ those of*^^^^

LATENT NEED FOR MENTAL HEALTH SERVICES / 35

LATENT NEED FOR MENTAL HEALTH SERVICES

During the past 20 years, several attempts have been made to assess the
demand for mental health services within our society. Although it had
been recognizecLthat traditional clinics and hospitals were already over-
burdened, it was also suspected that many individuals needing mental
health services were no t receiving them. Surveys like those of Hollings-
head and Redlich gave an indication of the extent to which people were
receiving traditional mental health care, but they provided no estimate of
how many others might possibly need these services.

A preliminary report published in 1956 (Leighton, 1956) provided
startling data concerning the prevalence of mental health problems in the
general community. Leighton reported an epidemiological study conduct-
ed by a Cornell University research group in a single county in Nova Sco-
tia. CarmdarT gcusih g ~on a small town of about 3000 within Stirling
County, this research group determined that roughly 47 out of 1000
ad ults were receivi ng care in local hospitals and clinics as o a given a e.
To answer the further question of how many people were equally in need
of service but were not receiving care, a random samp e o approxim
20 percent of the town was drawn, and efforts were made to interview all

derived from 283 respondents each of whom
waT in tervie wed from 45 minutes to several hours. Interviews we. c
ducted by eight different individuals, two of whom were psych.auas.S;
who helped to train the others, and all o w ' ^ aboul their

istering sociological questionnaires. S 1 ^ gastrointestinal symp-

general health, about physical compl as ^ jiffi.

toms or headaches, and about P syC Jj‘““ e ' pother questions concerned
cullies, mood variations, anxiety, an 5Uch as schoo ling and

the health of family members, general b*ckgr , lomes The in .

marital status, and whether or not t ey j through interviews

formation taken from these subjects was a uf^ente M ® Mmledgp 0 f
with the town’s two general practitione

each individual in the sample. different psychiatrists on a four-

Each respondent was rated by ° ur nresence of symptoms that

point scale: Point A on the scale ;" dicat ^ r nervous breakdown, anxiety
almost certainly indicated mental disorferj ^ ^ that probably

attacks) ; a rating of B reflecte P sociopathic behavior) ,

indicated psychiatric disorder (ast ima ' symptom such as big i

ratings were used for borderl ne cases ^ a physician) ; a D

blood pressure” was claimed but no ce of psychiatric symptoms. In
rating indicated that there was no significant judgment was ma

addition to the symptom rating, another s

36 / recent impetus for community approaches

by each evaluator This involved i rating of the degree to which the res
pondent was impaired by his symptoms Again a four point scale was
used no impairment was rated when there was zero to 10 percent 1 m
pairment a rating of mild signified that there was from 10 to 30 percent
impairment moderate signified that there was from 30 to 50 percent lm
pairment and a rating of severe indicated that there was greater than 50
percent impairment

Leightons results indicated that 37 percent of respondents received a
rating of A for symptoms and were judged to be impaired more than 10
percent A smaller percentage roughly 7 percent were also rated A for
symptoms but were judged to be impaired less than 10 percent A total
of 65 percent of the sample received symptom ratings of an A or B
Leighton estimated from these data that 370 individuals per 1000 of the
population studied need psychiatric treatment whether they are receiving
it or not These findings of a latent need for mental health services are
quite start ing in terms of what they portend as they demonstrate that the
jre\a uice o mental disorder is roughly eight times the number of indi
viduals being treated for mental disorder

t<>n StUd 7 ™ s not the onI >' one to suggest in enormous la
sioned hv tb * . menta healtl1 services Another study was one commis-
Research £ C ° mm ' ss '° n ^ The Umverstty of M.clugan Survey
lems America V lS i to determine what mental health prob-

Xre tw orn P Z le £"*, ’?“* they d ° *out these problems and

sample of Americans oveAVe'aL of 21^ ^ MP In th ’ S S ‘ Udy * Hrge
latton of the country with respect to ll repreSe " ,at,ve of tl,e total P°P U
tion and place of rcs,ri„ '° sex education income occupa

were excluded Thus the wouiTth' SUb)eC,S Insllt uuonalized individuals

ately proper, toned“ r l;,ro; P n :™ar a s;2rr Wd ~ ted an accur

were conducted by experienced „„ ' M Amencan “dulls Interviews

two hours erviewers and lasted approximately

Roughly 25 pereenfof'tLrTmc'rTOweV"'" 431 the preSent COnteXt
■n which professional help would have . rcp ?" ed haVlng had P robIems
those admitting having such problem « 1 ” ° £ S ° me USe ° ne of seven of
ly sought help of some kmd l’articularlV n r< P ° rled that they had aCtUal
those seeking help the maton^ dTrf ' y illu - r - n ' n attng was the fact that of
Iished mental health profession^ WhereasTst ^ ° f the es tab

help from mental health professmmi* ^ >erc€nt of thls group sought
and social workers and 10 percent receded 3 * £Sycl ^tnsts^^EHoIc^ists
or marriage clinics a startling 49 percent Servi< f s £rom soc «l agencies
percent turned to physicians This *udv off 0 "^ da Wrnen jmd 19

great potential demand for mental heal* services ^t ™ dence of ,hc

s l nis latent demand is

MANPOWER PROJECTIONS IN THE MENTAL HEALTH FIELD / 37

reflected both in the large numbers who had problems with which they
felt they needed help, but who did not actually see anyone, and in the
numbers who actually sought out help, but who went to someone other
than a mental health professional

Another recent study attempted to assess the prevalence of untreated
mental disorder in New York City (Srole, Langner, Michael Opler, and
Rennie, 1962) This survey was conducted in an area within midtown
Manhattan More than 1600 residents of this area were selected random
ly and interviewed intensively Interviews were conducted m respondents
homes by psychiatric social workers, clinical psychologists, social case
workers, and social scientists These interviews were guided by a schedule
especially developed for this study and took an average of two hours to
complete Responses to the questionnaire were quantified through a rat
mg scale applied by psychiatrists associated with the study who attempted
to make an overall evaluation of the mental health of respondents, cate
gonzing each as well, mild, moderate, severe, or incapacitated on the a
sis of reported symptoms

The overall results of the Midtown study indicate that only IS 5 per
cent of the 1660 adults surveyed were classified as being well On the
other hand, 13 2 percent were seen to show marked symptom tat™.

7 5 percent showed severe symptoms and 2 7 percent were in P
ed The latter three categortes were combined to "

group consisting of 23 4 percent of the total sample The result of th.s
study also tndtcate a very marked need for mental health serv.ces m

fact that the mental health P— « ^
lie working at or well beyond their ]jk{ . those ated above

that come to their attention, the resu tentla) demand for men

are, indeed, frightening They sugge g P^ swamp t he existing
tal health services which, if manifes v these unme t needs de

professions For many in the menta J are dehver ed and m

mand change both in the manner in
the types of services rendered

MANPOWER PROJECTIONS IN THE MENTA
HEALTH FIELD / ' overworked and that

Granting that mental health workers P [D overwhelm the rcla
the potential demand for their ser '‘“ 0 fft. r senices what are t ic
tively small cadres currently P re P a so iution would seem to im0 vc
prospects for the future? The most i that they can

training more traditional professionals will.

58 / recent impetus for community approaches

turned out in numbers sufficient to meet future needs The potential for
applying this type of solution to the manpower problem was explored in
another study sponsored by the Joint Commission and earned out by A1
bee (1959) Albee s study concerned mainly the supply and demand for
mental health workers such as psychiatrists psychologists, psychiatric
nurses and psychiatric social workers
On the demand side of this issue Albee has pointed out that public
agencies have operated for many years without sufficient professionals to
provide an adequate level of care so that shortages within hospitals and
agencies are very long standing problems In addition this situation has
been aggravated in recent years by an enormously increased demand for
mental health services by agencies such as schools courts and prisons
which traditionally failed to utilize these services and by the fact that pri
vate practice is also absorbing greater numbers of professionals Thus A1
bee s survey indicated that only one fourth of the positions budgeted for
physicians and psychologists in state and county hospitals could be filled
at the time of his study Similarly roughly 20 percent of the jobs availa
, C ? r psychiatnc nurses and social workers were unfilled Still another
m’S.nn" 1 i,! Ct0r “ be reckoned w,th >n estimates of the demand for
AlhU “ ? "7°? ,S thlS C0Umr > S population expans, on
U e a „„ C ^ r ° S P eCtS * or increasing the supply of mental

though he found th meet growm B demand for their services A1
in psychiatry a very h" ‘ ncreasmg "umber of physicians are specializing
practice or devnt ^ 1® b P erccma S e o[ these individuals enter private

batUy^undentaffri "state .‘T Ume SUch P ra “- * a result, the

benefit from this mrr mS * ” tlons * or mentally disturbed do not
shortages CaSC 3nd contmue to suffer serious professional

creased considerably* Th y€3rS . the su PP ly °* psychologists has also in
only about'ontMhtrd Mall mvch^om™^ ^wever rn that

"here their skills contribute to Cnter clmical psychology

largest m, m ber arc employed as acad' ° ' men,aIly 1,1 ^ tar thC

shortages in social work are even 1 * eraicians Prospects for relieving
came socnl work is not atine. SS P r ° mism g than in psychology, be
tram Because the social n orker 'sTcil™ 3 "' 7 3S many students as « must
puhhc orcsen for the profession "'ll defined for the general

to utr-ict as min) students is they could V SC,00ls haVe not becn abk
that an additional 50 000 socnl \ n i acc °mmodate Albee estimated
"»> schools Of social isorkTere “ W ° Uld ^ needcd b V 196° and
Unhle the situation in social nort"" 1 ® " 0 m ° re tban 2000 P er >' ear
a good puhhc image and continues to Mnctm* * profe5s,on that en J°l' s
Ho"<uer shortages haic existed w ,hm Tr 5 '" 6 numbers o£ lra,n

the nursing profession for

PUBLIC HEALTH MEDICINE / 39

many years because the supply of trainees has not kept up with the de-
mand for their services, as a result of a 50 percent dropout rate occurring
primarily because of marriage. The situation with respect to psychiatric
nursing is even more serious. Although nearly one half of all hospital pa-
tients require psychiatric care, psychiatric nurses make up only about 5
percent of all those employed in hospitals. Thus prospects for the future
would suggest that unless psychiatric nursing can begin to attract a much
larger percentage of the total available pool, shortages in this profession
will increase with time.

Albee also pointed out that the resolution of mental health manpower
problems interacts with manpower problems in a variety of technical and
professional areas, primarily because all professions draw on the same
manpower pool — the young men and women who are being graduated
from colleges. When any one profession is successful in attracting re-
cruits, it necessarily creates a shortage in another field. Furthermore, to
the extent that there is, as Albee suspected, a general depreciation of in-
tellectual achievement within our society, all professions will suffer.

Albee’s overall conclusions were exceedingly pessimistic. Assuming a
goal of providing only “adequate” standards of health care, he foresaw
that the mental health professions would continue to fall behind in a -
trading manpower. Population growth and increasing competition or
manpower from new social agencies and educational institutions wou
increase manpower shortages. A reexamination by A oe c i e nia

er problem eight years after his original study (Albee. 1967) left htm
with little reason to alter his original pessimistic projections.

PUBLIC HEALTH MEDICINE

Another of the diverse streams contributing to the^mmun j^py ^ ^

torrent is the example provided by pu ■ ^ xhe public health

modern origins in the latter half of community . s mobilizing in the
approach was a significant instance of .Watened to wipe it out

face of serious plagues and epidemic; • toward concerted action

(Brown, 1969) . Threat drew people toge of the diseases

even in the absence of specific T-Sl Judies dealing with the
they were attempting to combat. Epi ° population provided some

rates and distribution of disorders wit in 0 ] vet j the 19th century

clues on which to act. A vivid examp e ° eral cases of the disease

cholera epidemic that swept London. fe parting their location

appeared, it became apparent to peop e ™ . were drawing their water

in the city that most of those who ^ere 1 crude epidemiologica

from a particular veil. This finding of a relame

40 / recent impetus for communtty approaches

study suggested an effective preventive procedure, even in the absence of
a full understanding of cholera s etiology —removal of the pump handle
from the suspect well Eventually the discovery of disease causing mi
croorgamsms advanced the cause of public health medicine significantly
This fundamental example of a broad gauge effort to uncover the cause
of a disorder, and the mounting of energetic efforts to prevent it, is ident
ical to the mission of tile community psychologist

PRESSURE FOR PREVENTING MENTAL ILLNESS

1

Growing pressure for concentrating on the prevention of mental illness
has been another recent contributor to the development of the commum
ty psychology mo\ement The idea of attempting to prevent development
of mental illness rather than only treating it after it has appeared is not a
new one It was proposed in the early 1900s by Dr Adolph Meyer, one
of the most influential psychiatrists of the 20th century (Meyer, 1948)
Meyer was greatly concerned with educating the public regarding the na
tore of mental illness and the workings of the mental hospital Further
more lie strongly supported the idea that the hospital should extend its
activity into the community, thereby breaking down the walls between
the mental institution and the general public He also spoke with enthusi
asm about ' aftercare/ a practice, then common m Europe, of preparing
a patient for going out into the community and for making his reentry as
smooth as possible In speaking to a hospital committee devoted to after
care, Meyer foresaw how such activity would eventually lead to a preven
ti\c approach tow ard mental disorder

I have always felt that the term ‘ aftercare' in the name of a
commit fee of tins character is one that limits the field of interest below
that nhich ts actually the result It is not only ' aftercare ' as it was estab
•Sit'd in England tlwt is to say, one or two months care for people who
Z, 7 "7 TrZ ° boardm £ Pi™ °r something of that nature,
Z '„ ZT S 0/ r ! g occu P aUon for Pattents who are leaning the mst,
the, r rZnZZZ ° ,7 “S'"" com mumly, and helping to make

u e il e T n community easy and safe against relapses There

andan'Z , m ° vcmcnt " mmi ‘he prophylaxis movement,

Tni Zn ” ' °Zr "I™ ,n ,Uc P^phylaxis of recurrences
thZ sZ le K 7 , T ‘ he Prevention of the first attacks, and

Many of Meyer's commcnls regarding the need for afiercare nreven
tmn, and a closer tie between .he mental institution and the communtty,

PRESSURE FOR PREVENTING MENTAL ILLNESS / 41

expressed over 60 years ago have a remarkably modern ring But de
spite Meyers early advancement of these ideas the mental health fields
did not utilize them until very recently Even the example of the intro-
duction of preventive approaches into general medicine failed to stimu
late activity in Meyers time toward the prevention of mental disorder
Rather than causing active resistance the preventive approaches simply
failed to arouse enthusiasm At the same time that Meyer was speaking
out for prevention psychoanalysis and the psychodynamic approach was
rising in prominence In the choice between Meyer s approach and psy
choanalytic procedures which promised to cure disorders that had been
puzzling for literally thousands of years the mental health fields found
greater glamor in Freud Thus the enthusiasm of mental health profes
sionals particularly in the United States was invested in psychoanalysis
and dynamic psychotherapies Even the profession of psychiatric social
work which developed as an integral part of the aftercare movement
eventually moved away from its original mission in the community and
followed the other mental health professions into the clinics and hospitals
where psychotherapy was being practiced Thus most elements of t e
preventive movement virtually disappeared from the mental health scene

£ “rr S u„ tll the 1940s that a caU lot prevents approaches was
again heard In this reawakening of interest in pre' rent,on
(1944) played an important role with his study of reac 1
ment Lmdemann had contact with a number of

reaved as the result of a fire in a in ° his obse rvat.ons of

1940s which killed approximately 500 > * identlfied acute grief

the bereaved victims of this catastrop . i v consistent psycho-

as a distinct syndrome that involves a set o re regular process

logical and somatic symptoms ^Ld tLugh

through which those successful in reelinvs of emit anger de

this syndrome This process typica y a)so noted ti lat many

pression and various somatic up ciatcd w ,th this process of nor

individuals threatened by the distress "„ C e ^together by resisting
mal grieving attempted to avoi efrorts t0 reS ist the discom

breaking down Lmdemann ssary working through process

fort of grief were an obstacle ess he remains preoccupied with

So long as the individual avoi s P red Lmdemann therefore

the dead person and his functioning i P ^ ho i oglC al mahdjust
asserted that the bereaved person ca p norma I mourning process
ment by permitting himself to engag assisting people m tins

Outsiders were seen to be potential^ belpb ,
process Clergymen particular y services

mumty who normally provided human

ell as other individuals in the com
as well as ouie ^ ^ Und or anolhc r

42 / recent tmpetus \or community approaches

were seen by Lindemann as capable of playing a significant role in pre-
venting mental disorder by encouraging the grieving process.

In 1948 Lindemann, with the assistance of private foundation support,
established a community mental health program in Wellesley, Massachu-
setts which became a laboratory for testing broad preventive techniques.
In the Wellesley program (Klein and Lindemann, 1961) service was of-
fered to all who faced “crises or predicaments.” These included threats to
specific individuals such as the loss or potential loss of significant rela-
tionships, the necessity to deal with a new person in one's social orbit,
and various types of transition in social status In addition, groups of in-
dividuals about to embark on potentially stressful experiences, such as
student nurses about to enter training and children about to begin kinder-
garten, were also offered group counseling.

By 1961, Caplan (1961) was able to report that 16 different studies
had been devoted to the prevention of emotional disturbance in children.
A few years later the same author (Caplan, 1964) wrote a textbook de-
signed to help mental health professionals to establish preventive pro-
grams In his definition of the term “preventive psychiatry,” Caplan dis-
tinguished between the three types of preventive efforts. The first, called
primary prevention, is intended to reduce the incidence of mental disor-
ders of all types in the community. The second, termed secondary pre-
vention, is aimed at reducing the duration of disorders that have already
occurred. The third, tertiary prevention, seeks to reduce impairment that
may have resulted trom some manifest mental disorder.

Primary Prevention

To lower the overall rate of new cases of mental illness, it js necessary

LITh r S ' an v l C ‘ rCUmStanCeS that P roduce “<* disorder and ’alter
” r , n If an °PP° r tunity t° exercise their influence? iHThir-

conn-nt' T, T* 6 cra P llasIzed that primary prevention is a community
an,,? in ‘ T " 0t f* to deaI with th ' problems of a specific individu-
ion re ? UK the risk of ™"> a ' disorder for alTentire popula-

m^be-rsof a “ *° ™ Me an optimal situation forjtll

to whatever cSTtlT ° n S ° that tbey W ‘" ^ able to ada Pt constructively
must identify c - 67 encoumer - ’ rhus the primary preventive prbgram

ror?ir to ?", ro :’ mcnia v nnucnccs that are «•

™phn reco? ‘ ^ '° r resi5tin S ad «™ influences.

J! n C08n, . Z “ th . at toSemeoEUmallyeffective nrimarv preventive ,

vironmcntal forces need sn? “ , pretty good idea ° E what - en ‘

these forces can he m<» * > ° 1 ° P artlc ular types of disorder and how

den. r o “t,“?I l ”' d '° build «*«“« fSPinst such disor-
However, Caplan feels that primary prevention is feasible despite

PRESSURE FOR PREVENTING MENTAL ILLNESS / 43

the fact that we know far less about the etiology of most mental disorder
than is optimal. He points to examples in public health medicine in which
many successful primary preventive programs were established before the
etiologies of the illnesses that they prevented were well understood.
Smallpox was prevented by vaccination, for example, long before the
causes of the disease were well understood. Likewise, major advances
were made in the control of infectious disease in cities long before the ad-
vent of the germ theory and the discovery of microbial agents. Thus Ca-
plan believes that one can rely on the best current knowledge of factors
that seem to be associated with the presence or absence of a disorder and
build a program based on that knowledge. Again, looking to examples of-
fered by public health medicine, Caplan points out that the smallpox vac-
cine was developed by Jenner who noticed that those who had previously
contracted cowpox seemed immune to smallpox. The hygienic reformers
of the 19th century acted on an unsophisticated belief that dirt and squal-
or were unhealthy and on their observation that epidemics of infectmus
disease tended to occur in congested cities but not in rural areas. c
earlier cited example of London's 19th-century cholera epi emic, w ic
was checked by removal of the pump handle from the well out of winch
most of its victims were drawing their water, is also illustrative of Ca-

Pl Given“our imperfect knowledge of the etiology of mental disorder,
however, some other basis for directing primary presen i
must be developed. Caplan feels that a conceptual model «

signed to guide preventive efforts. In essence he sees s -nth. . e
sembling fhe small-scale map of a region that * 5 [ ’ |

automobile but does not provide the kind of detail i pe
prefers to have. Therefore, the model P Tma n presendve Fo^ms.
certain major outlines and directions or p

Caplan's Conceptual Model for Primary Prevention

A fundamental assumption in .^P^-^ppropHme' to hiV’particul.u
disorder every individual nec S1 .^supplies arc specified in this mod-

stage of development. Three Quantitative or qualitative

el: physical, psychosocial, an disorder just as insufficient food

deficiencies in these supplies malnutrition,

or excesses of the wrong kin growth and development and

Physical supplies are nectary or Th ,„ food, adequate

for tiie maintenance of good P* > sensory stimulation, and

shelter, opportunities for ^ a nK . a for means to protect one-

thc like arc fundamental. There

self from bodily harm.

42 / recent impetus jor community approaches

were seen by Lindemann as capable o£ playing a significant role in pre-
venting mental disorder by encouraging the grieving process.

In 1948 Lindemann, with the assistance of private foundation support,
established a community mental health program in Wellesley, Massachu-
setts which became a laboratory for testing broad preventive techniques.
In the Wellesley program (Klein and Lindemann, 1961) service was of-
fered to all who faced “crises or predicaments.” These included threats to
specific individuals such as the loss or potential loss of significant rela-
tionships, the necessity to deal with a new person in one's social orbit,
and various types of transition in social status. In addition, groups of in-
dividuals about to embark on potentially stressful experiences, such as
student nurses about to enter training and children about to begin kinder-
garten, were also offered group counseling.

By 1961, Caplan (1961) was able to report that 16 different studies
had been devoted to the prevention of emotional disturbance in children.
A few years later the same author (Caplan, 1964) wrote a textbook de-
signed to help mental health professionals to establish preventive pro-
grams. In his definition of the term “preventive psychiatry,” Caplan dis-
tinguished between the three types of preventive efforts. The first, called
primary prevention, is intended to reduce the incidence of mentaTdisor-
_crs of all types in the community. The second, termed secondary pre-
vention, is aimed at reducing the duration of disorders that hav e alrea dy
occurred. The third, tertiary prevention, seeks to reduce impairment that
may have resulted from some manifest mental disorder. ~ ‘ *"

Primary Prevention

»nT° 1 i° V ’ Cr 7 ? Vera11 rate oE new cases of mental illness, it is necessary
!L ' , " Slan< ? lh * circu mstances that produce such disorder and’alter
rcs “ th ,7 1 have a " opportunity to exercise their influence.' TiTthiS"
concent It A™ em P lias ized that primary prevention is a community
Sit? 01 7 l ? dCal With the P rob,ems of a specific individu-
tion its 11, „° rC ? UCC UlC rhk ° f memal border for an entire popula-
mend^rt' L T 7' ~ OTatC an °P ,imal ««„g situation toall

™ sXiese JT "' 1,,0n 50 that will be able to adapt constructively

must identify environ* enCOU ?^ r ‘ Thus the primary preventive program

pcZ^Erev^ni^,

oi mental disorder Tbit i” on”" aS ^“ ch as possible about the etioldgy
vironmemaHoZ ™'r have a P ret ‘V g°°d idea ot what cm

these o „ I'T "!"',' °T 10 Par,icular *«» of disorder and how

dcr, rCSiS ' anCC SUCh diS ° r '

I n reels that primary prevention is feasible despite

PRESSURE FOR PREVENTING MENTAL ILLNESS / 45

life to be turning points on which greater strength and competence have
been built. Efforts to assist the individual, therefore, to master crises, has
considerable potential for later prevention of mental disorder. On the ba-
sis of this conceptual model, Caplan offered concrete suggestions regard-
ing primary preventive programs

Primary Preventive Programs

Caplan described two primary preventive approaches: soc ial action
and inte rpersonal-action- Social action involves making changes Jn the
cdmm umLy;. inter personal action attempts to make changes in particular
i ndividuals that wi ll, in turn, have communitywide influence.

Social Action. The basic goal of social action is to improve the com-
munity so that it will provide needed physical, psychosocial, and socio-
cultural supplies andT at the same time, offer_assLstance to those Jjtcing
crliesTOne example of a social action program involves efforts to bring

about" commnnitywide_change^through influence pyer pol.ttcai
and legisiativejicUons. In such a program, mental health.consultation is.
offered to legislators and administrators and steps are taken to mod.ty
the general attitudes and behavior ofjsommumtyjnerabers.

- To achieve the " goa n T adequate physical supplies a ^numberof E jro-
grams can be established. A campaign to preven • program

children of paint containing lead is an e * an JP e ° * prenatal clinics and
focusing on physical supplies The^jtabl^htnent^^-^
of encouraging the lower soctoeconomi^ din jcs can provide reduces
example. T he prope rjnedicaLcar^tfi . o£ menta i disorders,

pregnancy complications which can ea o A vulnerability

kf^^Trelationship between .material taction thr0 ugh
to mental disorder suggests another avenue for soa^ ^

community planning. Menu il hea t family is provided with ade-

gra ms can help to a ssure that t e 1 stimulation and recreation

quate housing and opportunity

c onducive to me ntal health. social action aimed at pro-

There are many examples of P ro §™ significant psychosocial sup-
viding psychosocial supplies. Since on ships, legis lative and soaa

plie§_are— received - through fam ' ^ J . tegr i t y have primary preventive
Jhatjielp. to maintain fami > P ^ he ^fjarml.e5 have

pr ograms

impact. Legislators can ^ ****--- rpma in close to UK—
woriTopportiinitiesjinpwing them to rem-a. $ can be set up to

pWld^d^lT ^^- E £s”f the very young to M t needed
permit pregnanywomen. an m Welfare laws can be es, F

fegflb^Tproperly for *» *■“££* ,a^n reguirejlmceuple

tTSKw families to remain toge ; ’^-jSTteforca. divorcejs granted,
to cSKiulrwith. a -mental heaUh_K— -

be influenced to '“^ffif^ies and to

44 / recent impetus for community approaches

By the term psychosocial supplies, Caplan refers to the co gnitiv ejmd
emotional stimulation received through interaction with other people,
one's family, peers, and older persons. People have a variety of interper-
sonal needs that must be satisfied through interaction witlf other human
beings. Failure to satisfy needs such as those for love and affection, for
limitation and control, and for participating in social activities, can result
in emotional disorder. An "unhealthy relatibnship,” o ne in which the in-
dividual has little opportunity to satisfy his needs because~the peopfeThe
deals with don’t respect them or use him to satisfy their own needs,^an
result in mental disturbance. Furthermore, the disruption of previously
satisfactory relationships through death or disillusionment can also be
traumatic.

The term sociocultural supplies refers to those forces deriving fromjhe
expectations of others around the individual regarding his place in the
structure of society. These forces are determined by the customs an d va l-
ues of a culture and the social structure. The advantaged group in a sta-
ble society often inherit social roles that make it easy to develop
healthy personality. Being born in a disadvantaged group or in a society
that is itself unstable may hinder development. Furthermore, t hose born
in_a fp’oup rich in cultural heritage are more likely to be taught to deal
effectively with highly complicated problems of living. On the other
hand, when a society is in a transitional phase— as our own seems to be
in today— well tested ways of dealing with new problems are not likely^ to
have been developed. Under these circumstances the individual is forced
to rely heavily on his own resources.

In addition to the described needs for various types of supplies, the
ap an s conceptual model also views crisis resolution as playing a pivot-
intinm 'ti^? mary P revent ‘ on - we pointed out previously, crises are sit-
fnrtlicr « a u*? CrCa i tC raenta ^ disorder or can provide opportunities for
throueh ° °^- Ca Personality development involves passing

onc riLc rzr 0t rem phases - The business of passing from
selonmentil rri -^r ” . ~ C stressfu l and is considered to involve "de-
thcre are that arise from the ordi-
loss Of sunnlics nf C ' Cr> ° ne m ' lfc ' These usually involve a sudden
otls of up 2t tin T C - T 0r anot, ' er or the threat of such a lossT Per>-
tal crises •• The " >V s “ ua,ions oE 'his kind are termed "aedden-
dcr intensified and nro^re P aticn ts reveal that their disor-

these transitional staves^ T . a ,5 er ' ldme t0 master challenges posed at
rendered the individual' id, '' 'iT’ T t hlS fai,ure lo ad i ust s<;ems to havc
failures in resolution iJrlt , Pa , ’ C ° £ m ? etin S future crises. Successive
suit is mental illness On "theVtl' malad j ustive progression .and the re-
faced significant crises mi 1Cr iand> man y individuals who have
^ cant enscs and sunnounted tliem havc found such periods of

5 FOR PREVENTING MENTAL ILLNESS / 47

consultation services in settings such as these can have primary preven-
tive impact through lessening crisis stress.

Services that help foster healthy crisis coping are generally adminis-
tered through agencies or professionals who are themselves often un-
trained in mental health work. To enhance such services, consultation
must be offered to these agencies and groups. Obstetricians, for example,
can be encouraged to be more sensitive to their patient’s psychological
needs. Agencies can be encouraged to abandon traditional routine, which
imposes long time spans between initial appeals for help and the time
when concrete service is provided. Since these social approaches are in-
trusive and often ask agencies and professionals to broaden their service
goals, they are difficult to apply.

Another avenue for helping individuals to withstand crises is through
education. Children can be t aught to analyze the causal factors behind
si tua tions _and-tolpIa n _e ffective responses based on complete understand-
ing. Likewise, the "character budding" aspects of certain forms of train-
ing may be useful to better prepare people for handling future crises

InteXpexSSmaLAction. Primary prevention through interpersonal action
involves face-to-f ace contact .between a mental health pro essiona ap
individualsjor_small- groups. Although the immediate focus in sue in i e
ac tion is . theJ ndividual , the impact of the mental ea wo < {ar _

hopefully. will be communitywide. To maximize t at 1 e *
getsof the mentaTSh worker’s efforts are chosen
community members whose role tends to affect t le m

many others are highly desirable choices. insure the

The interpersonal action approach can be An

provision of basi c supplies as well as.tojssist in e nt jfication and.

example of a program focusing on basic supp c hildliuch a

ameliora ti on_oLdis turhecLrela tionships tween ^ rh;]d { nter ac-

^^uld be based in a well-baby chntc where „ rdat .

"ons can be observed. Often it can needs but

ing to her child on some basts that sa t mion before the baby’s

ignores the needs of the child. Counse t g reIat ionship can serve

development has been adversely affected by this

an important prevention function. in a position to sup

Mothers of young children are n -vrreise authority, such as the

ply the basic needs of others. Many w arme( j f orces , the warden of
foreman in an industrial plant, officers in mmun ity are in a position
a prison, and the administrative leaders o dicdon The best inten-

to provide basic supplies to those wit c f the implications of their

tioned of these individuals may e u -..u 0 rdinates. Others in such key
actions for the mental health of t ^ r . pro blems. In either case,
positions may use their role to resolve their P

46 / recent impetus for community approaches

Homemaker services can be provided to families whose integrity is
threatened by serious illness. Hospital policies can be^haped-Jroiiiriimize
periods of separation between mother and child when either i s serious ly
ill. Public_education_ programs can be provided for par ents to increas e
their understanding of their children’s needs.

Social action can most directly provide for cultural supplies through
influence over the educational system. For instance, as rapid technologi-
cal advance reduces the need for unskilled labor, schools might be en -
couraged to develop programs for young people that will be tter prepare
them for the more exacting requirements of the new industries. Further-
more, the community’s responsibility for educating its members need hot
necessarily end with high school.

Another way for the mental health specialist to increase socioc ultura l
supplies is through community organization efforts to o vercome ap athy
and to increase the effectiveness of citizen groups. Social action efforts
can provide sociocultural supplies for groups vulnerable to mental disor-
der because of social isolation, such as the aged. The community can be
encouraged to provide stimulating social and recreational facilities as well
as proper living arrangements. Legislators and administrators can be
influenced to be flexible concerning the age at which an individual must re-
tire The elderly can be encouraged to remain interested in the broad as-
pects of community life and to participate in social, political, and recrea-
tional programs.

Social A ctionjn^ Crisis Situations. Caplan identified twoways to pre-
'em maladjustment resulting from reactions.to crisis. The first involves
attempung to anticipate situations .that promote crises and to deal wih
! dhle l ^ "V “? have a - n 0S«iveJ n Buence The second involves pro-
l tW f eady Eaci "S a CTisi5 «o foster adaptive'S^g.
"here and tvh' lm P act ? stress!uI situations, it is necessary to, anticipate
mmmion .l- d. ", 5 “ Ua ' ions are to Caplan makes the as-

are hhcly to result Inches' HtTha Per '° dS engender stresse . s that
tcniion 1 m> ‘ . e ’ t ^ lere f° re , recommends that special at-

om ing £££ ° ° 5e be S*oning school, starting a college career, be-

SSci^rf marT ' ed ' b '. C ° min S having children, ex-

physically ill or are T 1 ™'- r “ ,nn& ln addition, individuals who are

f-K .ho: ^txsrinXrT which threaten f bodi,y

losetl one b\ hosnitiliTitJon v uffer,n g fr °m separation from a

-n also 1c a
|>cople facing manv nrohlcm^ vulnera hle. Concentrations of

munity agencies These ‘n l 1° *** md are often fou «d in specific com-

nursery pr ' nalal dini “- hospitals, divorce courts,

schooh. collie domimJfcT^T'n *1 primary °f the public

^ dormitories, and the offices of the clergyman. Providing

PRESSURE FOR PREVENTING MENTAL ILLNESS / 49

A reductio n in the prevalence of any disorder can occur either^because
factors c ausin g the disorder are .effectively eliminated, thereby diminish-
ing the rate of new c ases, or because the rate of old cases is lowered by
early detection of the disorde r an d effe ctive treatment. The first of these
approaches is, of course, primary prevention. Secondary prevention tends
to focus on the latter course. It is obvious, however, that successful pri-
mary preventive efforts necessarily have secondary prevention impact.

It might be argued that early diagnosis and effective treatment of any
mental disorder is simply a part of what has long been regarded as good
mental health care, since successful treatment of any individual with a
mental disorder removes him from the pool of established cases Of that
disorder and, to some extent, lowers its prevalence. However, removal of
a few cases from the prevalence pool may have very little effect on the
overall prevalence figure if the pool is a very large one. In such instances,
to have significant impact on the prevalence of the disorder, large num
bers of individuals must have their illnesses shortened^ Therefore to
qualify as a secondary prevention program, preventive e orts must c ea
with disorders on a large scale and must make recognizable differenc
overall community rates. The reach of the mental health wor ^ r ^ t e ^
tend not only to those troubled individuals who seek him ou but to wher-
ever such problems are found in the community. _ aysjnu
locatin g thes e.problems and of extending mental health expe

^Essential to any secondary preventive program deprocedures for d,
tectingjhejnssence of -a. disorder asjar as^po ^ tradi .

require specialized techniques for dete g pe t Screening pro-

tional diagnostic fools offer relatively itt e in , hic characteristics

ced ures th at focus on, certain behaviors or on demographic
maybesuitableJn many cases-

individuals to

proceuuica

making" earlv ~Teferrals mu st be accompanie y j n f orma tion pro-

tfeatment^agencies Jo_deal_with_these J . nc | ul j e information as to

grams aimed at encouraging early re hennorei ^ ar riers between the
where individuals can be 'facilitate refetral The

Sharpening_early detection P re P arinf!

agency and the. community must t t i 0 n from which referrals

■aged cyTt self must be located close to P° ^ t hat ordinarily delays
are likely to be made, and the bureaucra -' wa Ik-in clinics” have_bcen
treatment must be reduced. - -ph^e a re open on a 24-hour

establis hed precisely to_a chieye t 1S ' r c ert ain settings, such as
" Basis to receive any one who comes ° more reac 1ily than others

schools and the armed forces, len ^ develo p me nt of secondary

to large-scale screening programs an
prevention programs.

48 / recent impetus for community approaches

one lias an opportunity to institute primary preventive measures through
interpersonal action directed at such authorities

The education of community leaders concerning mental health needs is
another opportunity for the use of interpersonal action to increase the
supply of basic needs m the community Changing attitudes among key
community leaders or important influence groups such as parents or pro-
fessionals can have significant primary preventive impact Such interper
sonal action approaches obviously overlap with what has been described
as social action

Interpersonal action can be directed toward crisis coping as well as to-
ward increasing basic supplies This can be done either by intervening di
rcctly with individuals who are in crisis or by consulting with care giving
professionals who often deal with individuals and families facing crises
Tojntenene directly m crises the mental health specialist must make
contact with individuals confronted by critical circumstanc es m commu n
ity locations to which they are likely to be drawn Prenatal clinics hospi
tals dt\orce courts and the freshmen dormitories of the university are all
examples of locations In these settings efforts must be made to identify
those failing to adapt well to crisis and to assist them while the crisis is
still in progress This is the method that was described by Lindemann
(1914) in his work with the recently bereaved
To broaden the scope of a crisis coping program the efforts of the
mental health professional can be extended by enlisting the cooperation
of community caregivers Caregivers are community agents whose_rcrt e
‘ll 5 to foster the well being of community members but who ar e not ne c
c — ' ly considered to have a mental health Junction Physicianv_nffl ses
social workers teachers lawyers and clergymen are all examples of pro-
fessionals who fulfill a care giving role in the community To extend pre
semne efforts through these individuals the mental health professional
must educate as well as consult and support care givers Caplan sees the
support provided to the care giving professional by the mental health spe
calist as an altogether crucial ingredient in primary prevention through
interpersonal action r

Secondary Prescntion

Secondary prevention involves reducing the rate of psychological disa

the nrev at P ° |,U ''"'° n r U, “ 11 * lhcsi: « directed toward lowering

h« f I 51 ’"', dl5 ° rdCr! Pre ' alence «*» «o the rate~of estab;

S™” ’ d,, ° r T at ' potnt m lime For many disorders a
To , " lhC 15 the target For example if

Z taTctTT"; scc °'7 r > prevention of involutional depression

^ri nanVZ 1 ' "° U ' d ^ mc 'topn„s.al women or men who are ex
periencmg t!ie climacteric

CONCLUSION / 51

however, they often fail to meet the needs of the patient who hopes to re-
t urn to the communit y. A rethinking of the goals of hospitalization and
the methods used to achieve them can make a very significant contribu-
tion to tertiary prevention.

Another approach to tertiary prevention involves setting up institutions
t hat are midw ay points between the sheltered hospital and the communi-
^ty/The demands of the” mental hospital environment and that of the gen-
eral community may be so disparate that some patients have difficulty
adjusting readily. Their adjustment can be assisted by discharge to transi-
tional institutions such as halfway houses, day hospitals, night hospitals,
and the like. Such institutions can wean the patient away from dependen-
cy on a highly protective environment. Special clubs formed by ex-mental
patients, akin to Alcoholics Anonymous, fulfill a similar purpose.

Another obvious tertiary preventive approach is occupational rehabili-
tation. In these programs the patient's job aptitudes and capacities are as-
sesseSTusually during the latter part of his hospital stay, and are com-
pared to existing work opportunities Retraining is provided where new
skills will better fit the patient into the local labor market. Many com-
munities sponsor sheltered workshops within which discharged patients
can work for a period of time free of the demands of ordinary employ-
ment, but where they can have an opportunity to bui up e P
under supervisors who know of their problems and are care u
overburden them. Locating job opportunities for isc targe P ‘

other service provided by rehabilitation programs In many ins ances t
may*be facilitated by offering consultation to the employer regarding
handling of such workers.

CONCLUSION

- , U pchnn of why community psychology 1
:his chapter begins with the ques is not a simple one. A num-

merging at this particular time Th period of time> seem to

er of forces, converging at roughly are suc h factors as a dis-

iave contributed. Involved in this deve op ition G f the serious ine-

atisfaction with traditional functions, t e distributed in our society,
[uities in the way mental health services f or mental health serv-

he growing awareness of huge potentia an d a hopelessness with

ces far beyond those that are already m ' health manpower to

espect to our capacity to train tra Itl0 " ions t hat are pointed to by

aeet society’s needs, as well as the new yent mental disorder. ,c

hose espousing more energetic e or s d an energetic movement

ombination of all of these forces to P ^ ^ deal with a variety of

oward creating community-oriented pr t,

50 / recent impetus jor community approaches

Tertiary Prevention

The focus in tertiary prevention is on the individual wh o has suffered
mental disorder, has been treated, and is trying to readj ust to communit y
life*. The_goal_is to eliminate residual 'effects of ment al illness and to
strengthen the individual so that he can contribute to the gen eral qu ality
oHife in his community. The rehabilitation of the recovered' mental p a-
tient is, therefore , the primary aim of tertiary prevention. Of course, pri-
mary preventive or secondary preventive programs" also serve this end
and, therefore, overlap considerably with tertiary prevention.

Caplan believed that a variety of ^large-scale efforts _t oward redu cing
residua l def ect in individuals who have suffered mental disorder are pos-
sible. One program of this kind invo lves public education abo ut the n a-
ture of mental disorder. Frequently people living with someone who has
become mentally ill are most familiar with his behavior in the early stages
of the disorder, when he may have appeared at his worst. During hospi-
talization, his gradual change toward a more normal state is not readily
o served; stereotyped fantasies develop regarding what his behavior is
apt to be like when he has returned home, so that the people around the
ex-patient may apprehensively expect to see again the bizarre behavior
tat took him to the hospital in the first place Programs of.publicxduca-
ion and consultation with family members can help to short-circuit fan-
p" n m ‘ S £ , ‘ ded “Potions about the patient’s conditlS^Tnd as-
he wll ', be re “ ived in a " optimally helpful atmosphere?
he has Pf, , P - r ° e ™, that the returnin S mental patient faces is that once
loneed tenrls*, ,OCIa |L 5ettI o g for a while, the social system to which he be-
the system A ° 163 i USt * Way tbat transf ers his old roles to others in
o res ™ ’ r '“S’ ‘he “.patient often finds it difficult

peers T, a m °?, er P p.“ ' n “* fami] ?’ a ‘ and among his social

go to a hospital he finds'f S T my haS been weakened by having had to
return to. The seriomn W ( t* uncertaint y in not having his old role to

the periodic hospitaiization'a'V’h’h' 6 ” be le 5 sencd by min imizing

•be patient, his family, his friCTds^Sd a, ™ a, _ nin S close “ ntact between
of illness Furthermore, professionals wmV W °' kers during Jhepffi^
it Clear to those concerned that he Jill be r‘" B ™ h the P atient canjnaKe-
expected centually to resume his former rote™'"® a " d tbatJ?e shfiHljU,e

by "'e mental tn"tu“oTS°rt hS bKom'^b P reVenlion can 1x1 m:ldc

bring conditions in the tynicaf mental . Dme . °b vlous ln recent years that
the deterioration of patient hew hos P ltal often contribute toward
-he hospital. « Wqu,d be ada Pbve omside of

-

REFERENCES / 53

Levitt, E E The results of psychotherapy with children in evaluation Journal
of Consulting Psychology, 1957, 21, 189-196
Lindemann, E Symptomatology and management of acute grief American
Journal of Psychiatry, 1911, 101, 14I-H8
Lorion, R p Socioeconomic status and traditional treatment approaches
reconsidered Psychological Bulletin, 1973 7 9 263-270
Meyer, A Aftercare and prophylaxis In A Lief (Ed), The commonsense
psychiatry of Dr Adolph Meyer New York McGrawHdl 1948 Pp 300-311
Rosenzwcjg S The effects of psychotherapy i reply to Hans Eysenck Journal of
Abnormat and Soctal Psychology, 1954, 49, 278-304
Simu V I) Sociocitltur ll ispccts of psychotherapy uul treatment t review of
the literature In L E Abt U Beliak (Eds) Progress in clinical
psychology, Vol 111 New York Gnine and Stratton, 1966 Pp 151-190
Schofield, W Psychotherapy the purchase of friendship Englewood Cliffs N J
Prentice Hall, 1964

Shakow, D , R. Rapaport, D The influence of Freud on American psychology
Psychological Issues Vol IV, No I New York International Untversit.es
Press, Inc, 1 9G4

Srole, L , Ltngner, T S, Michael. S T , Opler M k H»« I A C Mental
health m the metropolis Vol I New York McGrawHill 196.!

52 / recent tmpetus for community approaches

mental health problems The next section of this book describes many of
these programs

References

Albee, G W Mental health manpower trends New York Basic Books, 1959
Bindn, D Psychotherapy and recovery from neuroses Journal of Abnormal and
Social Psychology, 1956, 53, 251-254

Brown, B S Philosophy and scope of extended clime activities In A J
Bmdman, &. A D Spiegel (Eds), Perspectives in community mental health
Chicago Aid me Publishing Co, 1969 Pp 41-53
Caplan. G Prevention of mental disorders in children Initial explorations, New
York Basic Books, 1961

Cartwright, D S Effectiveness of psychotherapy a critique of the spontaneous
mission argument Journal of Counseling Psychology, 1955, 2, 299-296

n&vrhnilwt S N ° 1 t ° n ( ^ ian S es ,n psychoneurotic patients with and without
P y apy Journal of Consulting Psychology, 1956, 20, 403-404

direct inn E f nei ^ e,U a PP roac hes to mental health problems an overview and
Em rZt °:/ Ut T W ° rk In E L Cowen . E A Gardner, fc M Zax (Eds),

nr, Lus mi heaUh p,obUms New York A PP ,etonCen

^"e'l T nUl health fields ,odi >y •»«« and problems In

mental health probUmr^YoTk'A Z 7 <E f £mer «'"' approaches to
Do Q,™, R , Levs I , Z ' 1 APP 1 ' 1 ™ Century Crofts, 1967 Pp 3-29

psychotherapy lournnl t M ^ note on atte mpted evaluations of

E,it? ° Cal Wolog,. 1954, 10, 233-235

815-828 0! '' ' '" CS f ° r 3 preventive psychiatry Pediatrics, 1962, 30,

Pr)rAo/ojy T I , 952 ^;”, 5 3 l 9 -S 24 ’ 0thCraPy eva,uat ‘° n Journal of Consulting

ol abnormal psyeholo ^ Eysenck (Ed ) . Handbook

SSr, ^fenc.,;,Nv z pp “

Holltnpheatl, A G . 8. Rctlhdi, F C s,m„t ,t l

study New \ork Wiley, 1958 **** an d mental illness a community

Joint Commission on Mental Illness and Ha-,1, k

'ork nasic Books, 1961 eaUh Act *°n for mental health New

Klein, D C. &. Lindcminn, E. Pres emu a

crisis situations In G Canlan /Fd\ nent,on m individual and family
Children Nets Wk Banc Hooks. 1961 Pp^JOG °’ d ‘ ,0rdtrl

tn a small town

THE HOUSEWIFE PSYCHOTHERAPIST / 55

THE HOUSEWIFE PSYCHOTHERAPIST

In 1958, Rioch, concerned by the manpower shortages in the mental
health fields, embarked on a program to use community resources more
effectively in treating established mental disorder (Rioch, 1967, Rioch,
Elkes, Flint, Usdansky, Newman, and Silber, 1963) Rioch and her co-
workers reasoned that manpower shortages were not going to be resolved
by encouraging young people to choose careers in the mental health
fields She recognized that even if one could successfully attract young
students to mental health, it would be at the expense of luring them away
from careers in other fields, such as general medicine or teaching where
critical manpower shortages also exist Rioch's program, therefore, fo-
cused on the development of a heretofore untapped source of manpower
The group she chose to concentrate on would not ordinarily enter any of
the professions but might, nonetheless, possess talent for mental healt i
work— housewives whose children have grown and who are ready for

second careers , , ...

The truly hold and innovat.ve feature of Rmch's program was that he
intended to train housewives to practice what had been redded a* tint
most complex of the mental health workerhact.v.ues, psychotherapy
She set out to train housewives in a relatively s ort an Smce s ^ e

gram that focused specifically on ° b ‘e fXime smdents, might not
was dealing with women who could n tradltl0n al graduate tram

have the educational background to qu« y compete with bright

mg’ and would certainly feel ' R f 0 c h felt that an entirely

youngsters after many years away from ^ she dou bted that the

unique training program was d cou id produce a broadly

two-year training program that she nabo rators decided to ernpha

skilled psychotherapist, Rioch and The rea dily

size training for work with patients rom where t h e program was

available pool of adolescents found in it ^ inClden t a lly, their

conducted prompted a focus on t li J

parents who were approaching nu e a S® ’ . through community lead

Recruits for Rioch’s program were 50 ot her organizations likely to
ers, PTA groups, women’s associations, ^ nQ assuranC es of future
produce suitable applicants Despite . 50 serious applicants re

employment could be given, appro . desired , the selection task was
sponded Since only eight students wa$ deve ioped in which each

difficult A preliminary screening pr 1500 w0 rds and participa

applicant wrote an autobiography ° bt to ten in four or \e °*
with staff members in groups o r croup was required to ta e
discussions on a variety of topics

3- community programs for

ti adit tonal problems in schools
clinics , and hospitals

in Chapter 1, ti le'prot^Ll!'' . defin ‘ tlons o£ community psychiatry quoted
the fact that coramun^fcree! ^ ~ ^, UUS Chlpler take co S mzance ot
nation of many psychoLncal disord^ ‘° *' develo P m(;nt or P^P* 1
used more efFccmeh m CrS ’ ° r that the commu mty 030 **

grams focus on already manifest V*** dlSOrders Essentially these pro*
represent efforts to tmproac method^ d" 3 ,’ dl5turbance As 5uch ’ they
dcr. and ssnhin the presentne framei „n l'" 6 W “ h P s V cholo gi caI d,sor
non Tlte locus for these programs has M hey re P resent '“hary proven
mental hospttal. the public sTools and ,1 qU “ e Vmed ’ mcludmS **
One of the pioneer community n/ 1 out patient treatment setting
Dr Margaret Rioch,” P ^ ° £ Ull! «as deseloped by

THE HOUSEWIFE PSYCHOTHERAPIST / 57

a filmed 30-minute interview conducted by a psychiatrist with a female
patient was viewed by Rioch’s trainees, groups of first-year psychiatric
residents, and second- and third-year psychiatric residents, senior medical
students, freshman medical students, and hospital volunteer workers. All
subjects were ashed to make ratings of the patient’s background, present
status, prognosis, and dynamics. Mean ratings of each group were corre-
lated with the mean ratings of a criterion group consisting of five experi-
enced members of the psychiatric faculty of a large medical school. The
performance of the Riocli trainees was found to be significantly poorer in
these comparisons than that of advanced psychiatric residents, but signifi-
cantly better than that of freshman medical students and hospital volun-
teers and on a par with that of first-year psychiatric residents and senior

medical students.

In the second of these evaluations (Magoon and Golann, 1966) a
three-year follow-up of the job performance of Rioch’s trainees was
done. Individual supervisors rated all trainees as average or a ove in
comparison to referrent groups of either new therapists or new y l ™ in ^
social workers. Interviews were also held with co-workers, and nearly
expressed very positive opinions of the trainees ski . , • hf

In the second program established by Rioch and her Mta eight
women were trained as counselors to mothers of young c i ' !c

entation in this approach was preventive in contras o counsc ] ors
orientation of the first program. It was envisionet receiving

would work with underprivileged women whose c i . centers,

services from child health clinics, nursery schools, or day-one

Si^mcantly. none of these are tradmona^nKnta dures simiIa r to

The second group of trainees, selec . background to the

those used for the first group, was ?"“* ! j.™' ' 0 gram, training was at
women selected in the first study. As ain considerable practi-

first clinically oriented, and throug -.rnhlem in this program was

. ^ ^ ctymiilv clear what is expected of a psy-

role definition. While it is reasonably cm ^ role „f a mental

chotlierapist in a traditional menta tea tQ ot her than mental

health counselor in a setting P rimar ‘ L . .. ue ; n spite of the fact that
health functions is bound to be fuzzy. cx j sts j or sorae one who

in the typical child health clinic ar > ° bvl ° - th thenl . Traditional per-
can listen to mothers' problems an co ” . . to perform this function,
sonnel have neither the time nor t ' . cI ; n | c m ust outline a role t >a

Still, the person who enters the child lie furthermore, since i the

is distinct from that of the others in . backgrounds compar

dime patients were of different ! o“ oc “^” nicat ion became a
the women training to be counselors, Rioch's went forth wi

ous problem. Thus, this second program

56 / community programs for traditional problems

one particular question and arrive at some consensus on it. They also lis-
tened to a tape-recorded interview and discussed their impressions of it.
On the basis of impressions formed of each applicant from these activi-
ties, the staff eliminated more than half the group. Those who remained
took psychological tests and were interviewed individually by the staff.

The general criteria of trainee selection included high intelligence, reli-
ability, psychological stability, nondefensiveness, ability to relate well to
others, and sensitivity to psychological subtlety. Other practical factors,
such as the prospect of geographical stability and the freedom to work a,
flexible 20-hour a week schedule, were also taken into consideration. The

nature and amount of the applicant’s previous education was not con-
sciously regarded as an important criterion. Ultimately, eight women, all
middle-class mothers, were selected. One was a widow and the rest were
married to professionals or executives. All were college graduates, three
having earned advanced degrees, and half the group had undergone more
than two years of psychoanalysis or psychotherapy.

The training program consisted of a combination of practical work and
supervision as well as lectures and seminars on personality development,
adolescence, family dynamics, and psychopathology. Clinical work and
supervision took place at the National Institute of Mental Health, Bethes-
da, Maryland, the base for the program, and in nearby community clin-
ics. I rainees also observed others conducting individual, group, and fam-
i y t crapy. The practical aspects of the training program were instituted
ery early, and considerable concrete experience was acquired before for-
mal theory was taught. n

mv*-* ° f pr ° Fam cvaIuat!ons were utilized. At the end of one
cordinrofTft'T.' reC ,f d ^ , !nterv!ews done by each student and re-
experienced US' 'h .t, ** E '™ tlcisim o£ lhe!r own interviews were sent to
nod. ne of .h^ aP ‘ StS '° r eva,uati °"- These evaluators, who knew

Ttt to raie : h r dequacy ° £ the ttaine f

middle of tlip vai* • a- • a ' era S e these ratings fell around the

Z ond l t r t 'tT 5 Sa,i . SfaC, ° ry P er£orma nce. At the end of the

eva°ua,in C ,'he nr„r‘* n T™™ WCTe invi,ed >° a Pend da V s
trainee readin/thfcn V memng 10 ta P ed interviews done by each
trainee for one hour ™ re P 0rts .«*«*» by each, and interviewing each
Another more tangib^rnto^oTtir' 011 “ r3ting 3,1 trainees h!gMy '
inratediately on °' ‘n P a 0gr3m ™ S **,

them by agencies in which they had done m ’ ^ J ' mOS ' ° f

done approximately four years a Lr t^d nation T’"?' 3 foll ° W ' U P

to be employed at least half-time. ^ all trainees were found

Two other formal evaluations of Rioch'^ Rrc» - ,

been reported. In the ftrs, of these (Golann,

UNDERGRADUATES AS CROUP THERAPISTS / 59

mental health services even of the most complex variety. In addition to
an obvious contribution to meeting immediate mental health needs, such
individuals can have an important primary preventive impact as well. By
providing an exciting and important role for people at a time when they
are faced with a reduced sense of importance, as may occur with a wom-
an whose family has grown up, such a program can help the trainee to
feel useful once again. Its potential advantages are obvious for groups
such as the retired, the physically handicapped, and many others with the
time and a need to give human service. Both helper and helpee have
much to gain.

UNDERGRADUATES AS GROUP THERAPISTS

The work of Rioch in the late 1950s has stimulated a search for other
manpower sources for traditional mental health functions. Poser (1966)
has reported one such effort in which he questioned die validity of the
assumption that considerable professional training was necessary to prac-
tice group psychotherapy. Poser compared the effects o group psyc m i
erapy of hospitalized schizophrenics carried out by experience p
sionals (psychiatrists, social workers, and occupations t ®P )

the effects of therapy groups led by untrained college underpaduateS;

Patients undergoing psychotherapy were matche or a *?’ ■ on ] y or .

ness, and length of hospital stay. Groups of patients tm^rgo ng^nly or
dinary hospital care were matched with those rece, ng
provide a no-group therapy control group- »‘j“ ” roiniraum of three tin-
an age of 47 and all were chron.cally d . ^ hatl a

interrupted years of hospitalization. T ^ - ou5 oeperi-

minimum of five years experience, and . „ ; n , hc s ,„dy were

■ence as a group psychotherapist. Untram mosl of w ) lom had

female undergraduates between the ages

never even taken a course in psycholop. h£)ur mce ting. five days

The psychotherapy program inv° ' e Therapists. both trained and
per week, throughout a five-month perio • encaged only in ver-

untrained, conducted sessions as they cs |[ ' nct j v jties such as party
bal communications; others arrange fiT painting- All therapist*
games, dances, public speaking, and communal p»»

stressed group interaction. » ccts 0 f the group therapy-

Poser used several criteria to equate the eBec ^ ^ {

These included: two psychomotor tes . JVT nbol test of the V ,v

reaction time (RT). two perceptual tes ’ ^ fonnicl tcJt (Stroop);
ler-Bellevuc Scale I (DS) and a co or ^ a w ord association trs

verbal tests, a test of verbal fluency

58 / community programs for traditional problems

considerable feeling of uncertainty and frustration on the part of both
students and program staff

From the beginning of the training program students placed in child
health clinics interviewed mothers took histones and counseled with
women referred by clinic staff or who on the basis of casual contact in
the waiting room seemed to need someone to talk to Interviews with
these women focused on a variety of topics such as housing problems
lack of clothing unemployment inadequate education or marital dis
cord In this work trainees found that referral to other agencies such as
psychiatric clinics welfare agencies or speech and hearing clinics was an
important part of their function Although prevention was their primary
goal the trainees often found it necessary to deal with the immediate
problems of the parent and sometimes an older child before it was possi
e to attend to the child who was the primary clinic patient In many in
stances trainees had only a single contact with mothers in the child health
clinic so that as much as possible had to be done within a very limited
periot o time Eventually students built up a case load of mothers who
piTh a , C repeatedIy and who could be counseled more intensively
Tn nrJ/ ain . eeS u Seem l d t0 Rnd the,r gratification in such cases

‘ f ‘""I. 0 1 Cir ChlW hea1th work trainees also had part time place-
children ° Cr Se ^ ln ^ s , suck as nursery schools where they observed
ptemLt " d 7 ,th m ° therS and C ° nSuIted Wlth ^achers Other
C.« and neighluitliood centers r " lty dmiCS fam ' ly and Ch ' ld SerV ‘“ ^

nars amUndnul Pr ,°® ram Keld trainin g was accompanied by case semi
Z T.aT" C ° UrSe work was throughout the

^”’ a '“V d -e,opm S e„t com

topics such as mental retardation S ^ 3 nUmber ° E
school consultation nt i, t dynamics the techniques of

Pr^.^ms frequently encounterecUn children pfenatal care and medlCal
The overall impact of Rmrh ,

extensively as the first Thp a C ° nd pro§ram was not evaluated as
program displayed remarkable ™ S tha ‘ tralneeS m th ’ S

From n,e experience of being limited iV" 7 a PP roach to P roblemS
l«s they learned to nse time opttmaUy PhT V ™ SeSS '° m W " h
"Inch trainees were placed nere um V Phys,clans ln char g<= of dimes in
trainees sen ices All expressed the e y alua,,ng thC

their clinics as counselors A further s,™ hat . ,ramees couId remain > n

— zzxzzzs:

•■mapped sources^rm^n^lifcrtha't'cTn'f^^d 'b 3 ' ' here 3re herelotor '

be used to perform badly needed

UNDERGRADUATES AS GROUP THERAPISTS / 61

Table 2. Covariance Adjusted Posttherapy Scores of Untreated Pa-
tients and Those Treated by Professional Therapists (from
Poser, 1966)

Treatment

TAP

VF

VAL

DS

RT

Stroop

Untreated
controls
(N — 63)

Mean

SD

45763

9.772

11.699

4 449

26218

6.580

20428

7204

.169

.054

2208

.768

Treated by
professional
therapists
(N = 145)

Mean

SD

t

46.372

9 894

.387

10 948
3.061

I 148

28104

6 950

1.427

23.187

5.612

2 313*

154

.049

1.688

.835

279

2.903*

•P< 02.

‘f <.01.

Table 3.

Covariance Adjusted Posttherapy Scores of Patients Treated
by Lay and Professional Therapists (from Poser. 1966)

Treatment

TAP

VF

VAL

DS

RT

Stroop

Treated by
lay therapists
(N - 87)

Mean

SD

49735

10222

12 600
4.370

28 786

8 264

24 135

6 812

.197

.0G3

1.025

298

Treated by
professional
therapists
(IV — 145)

Mean

SD

t

46 372

9 894

2 331*

10948

3061

2 899 b

28 104
6950

.588

23187

5 612

230

.154

249

4 998*

.835

279

256

•*><.05.

e p < . 001 .

_ nuite paradoxical. Rioch had

The findings in this study by ose f .j ^ trained in a two-) ear

demonstrated that intelligent housewi' indicate, however, tliat at

program to do psychotherapy. Posers i . a | tt) gether untrained thera-
least in working with chronic sc uzop ' t j jan trained professions s.

pists achieved better results in group 0 f the untrained under*

Poser has speculated that the nai\e c cx ibility to patient mood s i u
gtXtdbates r might have resulted in .f^^ nC ed therapists. Tins is sup-
than did the "professional stance - P* therapists engaged m
"or ted by the faet dm groups professional. It is also worth

tereo typed activities t

CO / community programs for traditional problems

(VAL) , and for some patients ratings on a scale measuring adjustment
to the hospital Before and after measurements were taken with all tests
and ratings In addition to being matched in the various therapy and con
trol groups for age severity of illness, and length of hospitalization, pa
tients were also matched for pretreatment test and rating scores
After treatment patients in groups led by untrained therapists were
compared on the six criterion tests to the no-treatment controls to which
they were matched They were found to do significantly better on four of
these tests (speed of tapping digit symbol, reaction time, and color word
conflict test) These results are depicted m Table 1
Comparisons of the groups treated by tratned therapists to their no-
treatment control groups revealed significantly better performance by the
treatec group on only two criterion tests (digit symbol and color word
conflict test) These results are shown in Table 2

lntercstln g however, were the direct comparisons between the
1 W W T P^ f0 ™ an “ ° f patients treated by untrained therapists
was reveler tramed thera P lsts as set forth m Table 3 Here it
cantlv Ix-tier ,1 5 * 6 P atlents of untrained therapists performed signifi
on tests fsiw i' a< i patients of trained therapists on three of the six criten
mgs had m n aPP T S Verba ' nuency and ™«.on tune) Ward rat
nuBing su^Z t ° n the Patients 01 the untrained therapists by
best The results of th" Y W3rd aKendams who knew particular patients
indicating significant 'l'™™" 8 * were ’equivocal with supervisors’ ratings
reflecting no change P ' ement af,er therapy and attendants’ ratings

Table 1

ne 0 nts n a a nd e T A h djU ^ d PosUhCTa Py Scores of Untreated Pa
tients and Those Treated by Lay Therapists (from Poser

Treatment
Untreated
controls
(N - 63)

Treated by

by therapists
(' = B7) m

Mean

SD

9 772 4 449

49 735 12 600

10.222 4.370

2 308* 1595

VAL

DS

RT

Stroop

26^18

20 428

169

2.508

6.580

7504

054

768

28 786

24135

197

IX>25

85W

6 812

063

698

1501«

2922’*

2 613

2 336*

v 83135"

COLLEGE STUDENT COMPANION PROCRAMS / 63

tv as felt that a self selecting process would take place whereby those who
■were unfit for the role would drop out of the program on their own
Those who remained with the program were simply instructed to be
themselves with patients No further preparation was offered Volunteers
were assigned specific days for visiting and, in time, specific projects were
planned and project leaders were appointed to organize each day’s activi
ties The position of daily unit coordinator was created to provide some
one to take charge of the day to day operations of the different volunteer
teams A sense of the variety of activities engaged in by volunteers is pro-
vided m Figure 1

10/9 Six of us altogether we spent two hours in E 3 talking with the pa
tients Organized an art class which proved to be great success with
many of the patients, who wish it to be continued We asked to take
patients to the courtyard, but were not allowed to, because the male
patients were already using it

10/16 Five people out tonight two took some patients bowling, and rest
stayed on ward playing bingo, singing doing jigsaw puzzles drawing
ond talking It would bo hard to be loo enthusiastic about the respon
siveness on E 3 this evening the pot, eels greeted us eagerly ond par
ticipated with remarkable interest and gusto in all activities

The supervisor of the word expressed delight of .he success of this
evening's work, and praised the activities; h hed ond miked with
(and to us) was the responsiveness of one who lo g
enthusiasm for the first time in many months

The only complaint was that we should <■"»<*“£

Next week one girl ,s going to bring equipment to give

“ted" "tonight, and many patients come up to us
afterwords ond told us that they hod hod a good
10/30 Seven people out tonight adwties inch

checkers, puzzles horseshoes 0 f men from D 3 pressed

Sometimes ,nE 3 we con see the silhouene , .

we can see the si a f ee | in g of associa

against the door, as though they ^ decide d to open the door,

hon or participation with our activity us f or gomes talking

ond see if they really were amenable to 1*^9 ^ nig M

11/10

„ per/they weren't amenable las, night

and other pastimes As it °PP Q f ew m0 re times
I think, though they might be w ry ^ ^ ^ ond , he E 3 at

Attended a group meeting with the

62 / community programs for traditional problems

noting that there was greater variability in post-treatment scores of pa-
tients in lay therapist groups than in professionally led groups. This sig-
gests that some patients in students’ groups responded very well while
others showed little or no improvement. By contrast, improvements
among patients in professionally led groups seemed to be more evenly
distributed among all group members.

Another program in which untrained college students have been used
as group therapists with hospitalized patients has been reported by Rap*
paport, Chinsky, and Cowen (1971). In this program an attempt was
made to gauge the effectiveness of group therapy offered by untrained
college students supervised by graduate students. Two hundred and fifty-
six chronic hospital patients were divided into 32 matched groups, half of
w nc were led by male and half by female therapists. Groups met for a
total of from 26 to 33 one-hour meetings distributed over a five and a
one-half month period. The criteria for evaluating the effects of this
reatment inc uded psychomotor, verbal, perceptual and perceptual-mo-
" „ aS „7, “ We " cognitive measures and behavior ratings. The out-
; 1 U - S S -c y '" dlcated 'hat male patients in groups led by females

cTnt d ffere 8 " Ca " y t m ° re “’ an "° treatIM nt “"‘ml groups. No signifi-
a male 1 d"rf We 7 f ° Und ^ the rema ™"8 S™P* (male patients with
female leader! Tv WUh 3 mak ***** patients with a

fects of the n t thls st,uly d,d not compare the therapeutic ef-

some"!, Zr tTo P° rf? 0 ™ 1 * wi ' h nonprofessionals, it *» lend

ried out by relatively unVainedVoupleXr 6101115 the " Py ““ ”*

COLLEGE STUDENT COMPANION PROGRAMS

cmcTgodTn^fcoUege";;"!™!™! mental hos P ital Plants have
■n 1951 when a student volunteer pr^am"’ 6 ‘ ° f the5e appeared

area as an outgrowth of a very small^ - t . 0rgan,zed in the Boston
bps brooks House Association at H-trv “ al .?f rv ' ce Program of the Phtl-
Dalismcr, Morrison, and Brcggin i%m ( ® reenblatt ' 1% 2i Untbarger,
from various colleges in the Tie., ’ ^ ' A PP ro xmaately 500 students

or boston Psychopathic Hospi, u" I*** dthe r Metropolitan State
About -10 percent of thisp"d e ^o a “ demic ^ 1954 I955 '

basts spending from one andone-halfto .J"° re . vis,ts > som e on a weekly
items Each visit was generally followed by a Visk p3 ',

what had taken place that day. bY a dlscusslon with staff of

in this program no screening was used to eliminate volunteers, since it

COI .LEGE STUDENT COMPANION PROGRAMS / 65

It was found tint 37 of the 120 patients left the hospital while they were
being worked with b> students and of these 28 of the 37 were still out at
the time of follow lip (for an average of 3 4 years) The 9 returnees had
remained out of the hospital an a\erage of 1 4 years Seven more patients
had left the hospital some months after they were seen for case aid work
and all remained out at follow up (for an average of 1 2 years each) Of
the 35 patients who were out of the hospital at the time of followup 2
were considered to be unimproved 10 were adjusting marginally 18
were considered improved and 5 were apparently well Considering that
the case aid volunteer was working with a chronic hospitalized patient
averaging in excess of 4 years of hospitalization the authors of this pro-
gram contend that the program was successful and attribute this success
to several factors First relationships with patients were maintained for
long periods of time Second the role definition of the case aid worker
was a relatively loose one permitting him to engage in a wide range of ac
tivities and to deal gradually with anxiety provoking material Finally t ie
activity of the case aide extended beyond the hospital walls and included
helping the patient to find employment and to adjust to fami y i e

Partially as a result of the case a.de experience a need was recognized
for a transitional institution or halfway house midway between he hos
pital and the outside world Many patients were seen to require the s p-
port of such an institution before they could reintegra e k

general society Therefore volunteer students an a ’°* p ’ ,, House

er planned and developed a transitional dwel ingca «

(Kantor 1962 Kan.or and Greenblalt 1962 Umbarber et a,
house was rented and funds raised to cove ”“' ™ camc f ro m several
the salaries of a resident couple F,n “""‘ boar £ P charge to students who
sources One was a |1000 yearly room operated as a coop-

could reside svtth the patients at Wellmet support

erattve State and government V ’ f(jr consu , tatl0 n but

Medical and psychiatric consultants s e[ wa5 that lt provided ex

perhaps the most important feature spontaneous friendships

patients with an opportunity to live an P (]ents live d a t Wellmet

with normal members of the commum y r f our were able to re

during its first year of operation \ « in took U p t heir own resi

turn to full time employment three o v

dence , n r the Boston program that

It is apparent from this capsule escT *P developed despite the lack o
this pioneering student participation e . ose goals All of the proj

well organized goals and plans for nnsl dered to have a tertiary pro
ects that have been developed can be psychotherapy as was the

ventive aim The focus has not been on

tendants Both the other volunteers and myself participated actively in
the discussions all our comments were well received
12/4 First time out after two week lapse for exams Enthusiastic reception,
with several break throughs to formerly uncommunicative or inactive
patients

12/18 Excellent results with I pstick applications and the lipstick to keep as a
bingo prize Established communication with patient who has never
spoken to us before she accepted a lipstick application from another
patient and seemed pleased at the compliments she drew

2/26 1 spoke to a group of patients tonight and asked them what they

thought of the idea of putting on some sort of play They seemed
genuinely interested and made their own suggestions as to what kind of
play they wanted-opinions ran high for a comedy, especially a light
musical comedy

Some of our volunteers came from Emerson College they will ap
proach the Theater Arts Department there for help in getting scripts

Ftgure 1 Excerpts from Adult Unit Diary (Umbarger et al 1962 p 26)

On one ward the volunteer project involved physical beautification and
wnu ga T Ul0n 0f groUp act,vitles Drab hospital walls were painted
w-ilk \vh °° rs Were car P eted and bright paintings were hung on the
tal chinny" 0 S ^ me P atients remained unstimulated by these environmen

SesSv'fn" 5 /^ mad u '° reach the,n *"<*>7 Students <™ d t0
bimuTand car l t ? lrough the vehicle oi group table games such as
unifstudent vo, ..I' UCh W ° U ' d £ °™ sraal ~t.on On a children's
relationships with e ' rs organized sports activitres and formed one to-one
wh ° starved for affection With a

TZ t ' jT Wh ° Kemed ca P a ble of leaving the hospital a

Mdua, patiSr^mThe^rT ft ’T™ ^
hospital life to community life Th« hls or her transition from

meeting their families and rh. i. h lnvolved taking patients on trips
"ell as visiting in the hospital C ‘" g ° U ‘ J ° b P lacement possibilities, as
Beck Kantor and Gehneau i,-

the changes in elm, cal and social 3 S ‘ Udy eValU3tmg

pated in the case aid program Between wK 7 *°. TO

"vt up

^ persona, and social adjuslmen.T^nt

SCHOOL PROCRAMS FOR THE DISTURBED CHILD / 67

The potentially high cost of such an approach was minimized by recruit
ing \olunteers from among the retired teachers who were housewives in
the community in which the program was developed In the selection of
these teachers, demonstrated adequacy as a mother was a prime criterion
The unpaid “teacher moms” worked two mornings per week under the
supervision of the educational staff and a psychiatrist To further limit
program costs, donated space at a local community center was used The
Board of Education provided transportation, books, and necessary pro-
fessional support

Two teacher moms, working with a given child two mornings per
week, provided a total of four mornings of individual instruction Teach
ing teams were briefed concerning the problems of their child, were given
appropriate educational materials, and were assisted by a teacher who
took care of supply and transportation problems Teaching programs
were highly individualized to meet both the emotional and educational
needs of the child, and efforts were made to integrate the activities of all
of the children, to use all modalities (motor, visual, auditory, tactual) in
the teaching process, and to limit distractions It was hope t lat a warm,
interpersonal relationship would develop between the child and his teach
er moms that would facilitate the learning process A typica sessi
child and his teacher mom is described in Figure 2

A typical morning for a child and his "teacher mom follows

The teacher mom meets her P ro|ec1 . child I os he^get;
escorts him to h,s assigned room and he^s ^ p rofe!sona | teacher-ln

then takes him to the "good morning roo , These consist of the

charge is waiting to conduct the opening I SW 1 The reading and d.s

salute to the flag and a short reading and i written on the blackboard,

cussion evolves from what the teacher in c arge ° flJ . f ^ e re admg level of
or from "show and tell " She tries to me u e se q paragraph about the
each of the children which, when put toge er ' , Wl th which the children
da/s weather, or a holiday or an e ^ n ^, ° r S ° ng exercises may last a very

are familiar Discussion is encouraged e .. manageability of the group
few minutes or as long as fifteen, contingent upon the ma g
that day Lq* secured the books, games.

While this is going forward the teacher ^ m her aMign ed room ready

and equipment she plans lo use that morn '£ ODenm g exercises She sits nex

to receive her child when he returns rom

and close to, the child, and the day's « ^ rcatJ mg senes and supple-
She may begin with reading, usually using

66 / community programs for traditional problems

case in Poser’s program, but on efforts to prepare the patient for living
outside of the hospital and to maximize his chances of staying out once
he left.

Following the example set by the Boston group, many other college
student companion programs have appeared in mental hospitals (Holz-
berg, Whiting, and Lowy, 1964; Klein and Zax, 1965) . In several of
these programs tertiary preventive goals have been well articulated from
the outset. Holzberg et al. (1964) have directed the focus of a compan-
ion program toward the socially isolated, “forgotten” patient. In addition
to the potential good that a companion might do for the patient, however,
Holzberg and his associates expected that the companion program would
have primary preventive impact by modifying the personality of the stu-
dent companion (Holzberg and Knapp, 1965) . A study was done, there-
fore, of the effects on the student companions of participation in a pro-
gram involving them with hospitalized patients. The results showed that
companions developed greater self-acceptance and became significantly
more tolerant in their judgments of sexual and aggressive behaviors than
students who had not participated in the hospital companion program
1967) ZbCrg ’ GCWirtZ ' and Ebner ’ 1964; Holzber g> Knapp, and Turner,

SCHOOL PROGRAMS FOR THE DISTURBED CHILD

Community programs are beginning to appear in which seriously dis-
turbed children are treated within a school or school-like setting rather
t lan placed in hospitals. Two prominent examples o£ such programs are
’7'™’°^ by Donalul e and Nichtern (Donahue, 1967; Donahue

"tT 1 ; 19 ® 5) , in Lon S Island and Project Re-ED (Hobbs, 1966;
Hobbs, 1968; Lewis, 1967) in Tennessee.

easoning that placing children in hospitals or residential treatment
from W 3 ™ Emg r fi K,i °n of the troubled child which isolates him
; iT- ° 0nallue and NM «era set up a project to deal
fe t ttin? ,T"r y d, , S,l, y bt;d , child '"thin the public school system. They
romance of h‘« ' ,‘ ld ! " his own community would reflect ac-

ma c Actno P , T '"I “ “ ‘ ruly em P ath ic, growth facilitating cli-

b e of conin? f'T /“ thc , scri0l ' sl y disturbed child is often no. capa-
Nkh.e m rlen, , TT ,hc ° rdina ry classroom, Donahue and

him camTnd 1” ^ Cd ~^ ^ »» aimed at helping
“d^r^r " the SySlem umil Ca P able of returning to the or-

dentandine " as 'hough, to require a warm, un-

derstanding teacher who could work with a child on a one-to-one basis.

SCHOOL PROGRAMS FOR THE DISTURBED CHILD / 69

child’s new school in case the> were needed while he was becoming acch
mated

Donahue (1967) has reported that of 21 severely disturbed children
treated in this program, II were able to return to regular classes where
the> made normal progress both in their studies and in their interpersonal
relationships with peers Considering the seventy of the disturbance of
these children and die bleak future that youngsters of this kind ordinarily
face, such an outcome is impressive Furthermore, the program cost is
trivial is hen compared to the high cost of residential treatment centers
and hospitals Some descriptions of improvements in specific children are
found in Figure 3

D C— Male— 7 years, 5 months His diagnosis was schizophrenic reaction of
childhood The situation was complicated by considerable pathology In the
total family situation His mother had been hospitalized for menta i ness, an
his father was also disturbed The child developed much better controls a longer
attention span, real enthusiasm for the work and learning situa ion, an
positive relationship to hts "teacher moms" and some of the other ‘ ,d ' en
hyperactivity was greatly reduced, and coordination s owe ™ d s

ment He was phased mto a regular first grade of twenty eight children and
now in sixth grade

B T -Female-7 years, 7 months Her interest in

mental retardation, poor coordination, sh 0 nd hype roctiv,ty

other children, poor hand eye coordinoti , d ond pra duce basic

B T progressed to the point that she cou a^ ^ £ roadened she acquired
forms Her attention span increased, an nroaram learned to identify

some impulse control, completed the rea ir j eS * c f mos t | e ast, first last,

and write her name, developed arrthmetica^ she „ now success-

sequence, bigger smaller, etc , and le . ^ educable, mentally

fully functioning in one of the districts

re,arded a , ^ schizophrenic reaction of

J A -Male-8 years, 8 months His d ‘ ag " c ® f OTI | ing He was hyperactive,
childhood with the severe regressive s y™P _ nof contained in the regu ar

harmful to others, and so disruptive t at ° . | family pathology His P ore " ' *

classroom In addition, there was ^fj^ls offered by the loco men al

would not cooperate with the therapeu i ( ,f, er apeutic milieu, t «

health center When placed ,n the ““^fty His soilng ceased His
progressed rapidly, both academically an

mentary materials available to the professional teachers of the district She is en
couraged to follow the teacher's manual more closely than a professional
teacher, because the manuals are well developed guides and provide compre
henslve directions on how to teach the series with which she is working From
reading she moves to other subject areas, such as arithmetic, spelling, language
skills, social studies, science These activities, interspersed at her discretion with
games, or talk, or a walk, listening to records go forward until 10 30 AM, at
which time there is a snack break She takes her child to a large room with a
long table and benches One of the children and his teacher mom have laid out
the cookies and milk beforehand— which is done on a rotating basis All the
children as a group sit down and have their snacks under the supervision of the
professional teacher-m charge

While the children are having their snacks, the teacher moms usually as
semble in the kitchen for coffee and cookies Here there Is much discussion of the
proiect children, although sometimes it is more social conversation than profes-
slonol The snack time and coffee break takes fifteen or twenty minutes, at the
„ ch ,ha teacller mom returns to her room to continue work with her
° owin 9 1 e plan for the day as agreed upon with the teacher in charge
twenn'rt, 91 ™!? QCtlvl,l f s are scheduled they usually occur during the time be
beams |„7, u° f 7? an ? ,he end of ,he mornin 9 At 11 45 the teacher mom
whattm rf:atl y tQ 9° name At this point she completes her log of

To thoM, s P !! d , W ’ 6 ,hm d °* °" d leaves „ w,th the teacher ,n charge
so that It Is available far her teammate teacher mom

In charae whtfn^ **]? rnornl " 9 stle l 105 probably been visited by the teacher

child's educationjprogram' 6 *** d ' r8C " 0n ° ncl 5U09eSt,OnS for f^hermg the

Nichtem 1965 pp 5sto°55) lne ^ and Hls Teac her Mom (from Donahue f

lcms Some had been diagnosed as lino h 3 Vanety ° f

sufTer mdd bra.n damage or were °‘ herS Were th °" S

amples are found in Fim, re 3 Th . , v _ C ° r mddl y dc£ectlve Some ex
t"° tears during which 1, me (lie goal "* the P ro S ram was aboUt

alb and emotionally to return to the ,1 pre P are the chlld education
such return was assessed by a team of 0rdmai 7 classroom Readiness for
a child was thought to be ready a r menta! heaIth professionals Wlien
ers at the child siade o£ vanous teach

men. was made a! 7 o wh" 1, teachl 'Z "h ^ **

Return to the classroom was gradual svlthm d ? S ”‘8 ht h* 51 SUIt hl ”
only one-half day per week Teacher me , ch ' ldren beginning svith
moms ordinarily stood by in the

SCHOOL PROGRAMS FOR THE DISTURBED CHILD / 7J

Project Re-ED (Hobbs, 1966, Hobbs, 1968; Lewis, 1967) is another
program for the school child who would normally be excluded from the
regular classroom because of his emotional problems. Unlike Donahue
and Nichtem’s program, project Re-ED is a partially residential program
in which children live at the school five days each week and at home on
weekends. Re-ED was started in 1961 as an experiment because of the
manpower shortages in the mental health fields, and because its origina-
tors questioned the effectiveness of traditional approaches to treating
children’s disorders. It represents an attempt to set up a "total education
milieu" for disturbed children. Unlike the typical residential hospital
which provides a few hours each week of professional attention but long
periods of relative inactivity, project Re-ED creates an atmosphere within
which a child's entire stay is oriented toward the goal of returning him to
the community.

Teachers for the Re-ED program are selected for teaching compe-
tence, unusual resourcefulness, and interest in working with the emotion-
ally disturbed. The 13 elementary school teachers who participated at the
beginning of the program, were selected and trained for nine months—
two quarters of academic work plus a three-month internship in a resi-
dential unit for emotionally disturbed children. When their training is
concluded, this program’s teachers become known as teac ler counse ors
and are assigned to a residential school. Within such as 100 , eig *
dren are assigned to two teacher counselors who design a co ^F
program for each child based on his needs and pro ems, an
objectives of his family, the referring agency, an t ic
T he emphasis throughout is on education rat er t an m< jji ^

language of the clinic - «

sensitive to emotional problems, the belier „„rv»rmost

helpful force in the adaption of • he di '‘“ r '^ E ‘ D ” mp P £ si ,e 5 setting up

Rather than traditional psychotherapy, example the child

concrete goals that can be reached in a psych*

with a reading problem is often regar Bu f jn ,hc Re-ED pro-

therapy with concomitant counseling t p ^ children with reading
gram it is assumed that a certain P er “ n *?£\ ^locational approaches,
problems will improve as the resu t an(J c g orts ar e made to

Therefore, an educational approach is ta . neC cssary for living

teach the child many of the basic attitu 5 s a rem ain in a classroom for
successfully in society. Reading, the a i 1 > peaceably with peers, and
long periods of time, the ability to get J\ , D f suc h goals,
the development of trust in adults are e\ P family agencies.

Referrals to the Re-ED program come ... nC ,,] y referred child it re-
or clinics. The history and current ^status f t fcrring agency. At this
viewed in a conference generally held with

relationships at home improved He began to relate well to the other children
in the program and was phased into a regular third grade on a half-time pro-
gram J A is now functioning well in sixth grade

C M Female 8 years, 1 month An aphasic child with organic involvement and
extensive emotional problems, this child was known to many clinics in New York
City as well as to some local mental health facilities which advised that she was
completely hopeless and should be totally exempted from school C M was a
completely withdrawn child She now enjoys physical contact She has improved
impulse control and appears to be a happy, attractive little girl who plays with
others and occasionally assumes a leadership role She was initially phased into
a secon grade, in the middle group in reading in her class, and is now in sixth
gra i e w ere she is reading on a sixth grade level She is anxious to learn and
wri i os an spells appropriately for her age Most important of all, she speaks—
n ac , at times s e is a chatterbox Though not always easy to understand, she
has a sizable vocabulary and a desire to communicate

behnvMv^ ? 1 DiagnosecI as a schizophrenic child with bizarre

arouD d,d T Qt tim ! S ' 6 hUrt ° ,her Ch ' ldren ' d,d not Palpate with the
mature demnnd^ 00 t0 reason,ng ' and was egocentric, autistic-like, im
physical Iv Inr " f ° extreme tem P er tantrums, and sulking R l was

his peers antf ° ", FT y c00rdina,ed He now has positive relationships with
much T V "f ° du " S H,S “° rd '"°"°n ■ improved He has lost

riy tsirr? rrap,,ve ,o He

voluntarily He ha V t,°L ^ chl,c,ren and sometimes shares willingly and

aCOdemiC ablh,y ' P— 1 -rly - ™,he

us need pencil and na ' CS Can solve P r °t>lems mentally that most of

and he ,s ’° "“h" 9 ^

residential setting n ° W m a l unior high school program in a

C C— Male— 8 years, 9 months r r i

who on the surface would «« , W ° S ° ia 9 nose d as a schizophrenic chile

Strated gross distortions in ♦ ° ° ° Severe beh avior problem He demon

and extreme unevenness of Der f P U ° ' Zat, ° n and visual motor perceptualizatior
all areas When he woTenlre tT” H 'V *** l» ad,ustmen, ,r

his academic program at the beginmna^He pr ° 9 , ram ' " was necessary to start
of approach He progressed to a fourth j mUch re P etl,| on and variety
competence ,n a regular seventh grade •hf'd °" d is now functioning with
otogy including severe marital diL^ n I** 9 "* ° fam,[ y w,th much P ath ‘
handling of the child nd extreme inconsistencies in the

Caw \

Figure 3
331).

»gnett« about Specific Children {from

Donahue 1967 , pp 380 and

SCHOOL PROGRAMS FOR THE DISTURBED CHILD / 73

cant elements in a child's social system, the child himself, his school, his
family, and any other relevant agencies within his community. This con-
trasts sharply with traditional psychotherapy approaches which tend to be
directed mainly toward the child.

A variety of evaluations of the Re-ED program have been undertaken.
At a simple cost level, Hobbs (1966) reported that the Re-ED school
costs about $20 to $25 per child per day. This was, at the time, about one
third the cost of other forms of residential treatment and approximately
four times the cost of custodial care. However, since the child tends to re-
main in the Re-ED program for a far shorter period of time than in cus-
todial care, the Re-ED cost per child served ($4000) is considerably less

than that of custodial care.

Granting that the Re-ED program is less expensive than traditional ap-
proaches for treating the disturbed child, the question of its effectiveness
remains. Weinstein (1969) has reported a study addressed to this issue.
Several approaches were taken to evaluate the Re-ED child s status a ter
discharge. One involved asking the following question of the referring
agency, which has had continuing contact with the child or his parents.
"Compared to enrollment is the child's adjustment now worse, je ’
slightly improved, moderately improved, or greatly ^P^yed Th same
question was asked of the child's parents sx months after beittmicd
home. The results of this evaluation effort indtca.e that w , « « «
percent of the children are regarded as hav.ng 'XTthef In a fu«her
erately by the referring agency. the utomer^and^^ ^ {a[hers

effort to assess parent views of the chil enrollment and again

were asked to rate the child's b« hav,or ‘^ f F “ The instrura ents used
at 6 and 18 months after d ' schar f.^.° , " 0 I ;i c m behavior such as crying,
were a symptom checklist that mdu ,, P maturity scale, and a discrepan-
temper tantrums, running away, as which the parent de-

cy score from a semantic differentia ^ parent wou ]d like him

scribes the way the child behaves, an . and fathers indicated

to behave. On all ol these instruments both "““^nt. The semantic
that Re-ED children had shown sigmfican F were less tense, less ag-
differential instrument indicated t ia t t le en gaged in the Re-ED pro-
gressive, and more dominant than ore . jidren as more outgoing,
gram. In addition, mothers regar e f orma nce, prior to the child s

To assess Program effects on schoo pe fiU qu[ a xrics of ques-
leaving his own school, teachers of his behavior. On the

tionnaires and to make ratings o ma chgrs w ere again asked to 1
child’s return from the Re-ED progr « • data in dicate that after t ie e-
out these instruments. Analyses o j j n their capacity to

ED program the children improved sigmfi

72 / community programs for traditional problems

conference concrete goals are set up for creating the kinds of behavior
changes that will make it possible for the child to return home promptly
When project Re ED was begun, severe psycho tics, the brain injured,
and the mentally retarded were excluded Eventually it was found that di
agnosis was not an important admission criterion, so that the likelihood a
child s specific problem could be ameliorated by the educational and
community program offered in Re ED became the most significant deter
minant of whether a child was accepted Thus a wide range of diagnostic
groups within the age range of 6 to 12 years is now being treated
New arrivals for the Re ED schools are assigned to groups, and indivi
dualized educational and social living programs are designed for them
Other group members are prepared for the newcomer and generally re
ceive him warmly The typical school day runs from 9 am to 3 pm
during which basic skills such as reading and arithmetic are emphasized
Specific content is determined by the particular needs the child has for a
given skill Nonacademic parts of each day are used to teach socially use
ful skills that are undeveloped such as kicking a football, roller skating,
swimming bike riding and, in the evenings, learning to live harmoniously
with peers and adults Periodic reviews are made of each child s progress
i ISC arge being arranged as soon as he is functioning well enough to
hifgrowth h ° me a " d communit y demands and seems likely to continue

havTiT* ^ K!r50nne ^ In P ro J ect Re ED are the teacher counselors who
by far s ™ a *°'. res P onslblllt y for planning each child’s program, and who,
h» dav tmdfv m ° 5t "T W,,h the chl,d ■" ‘he program They manage
the same . te ,h UCaU0n ' ern0tlOnaI S0C!a1 ’ relational needs At
way stauon for ^ Tm reCOgmze that the Re ED program is merely a
munity life * W Wh ° mUSt return eventually to full time com

inevuablyTpmt^f a? S fui ' dament: > 1 assumptions is that the child is
dy, school, neighborhood 3 aT™ -3 " eCologlral unit including his fam
imohed in the ovenli * community — other professionals must be

sible for raintamm 3 „ eatmem Thus a hLoo teacher respon

own school in the community ^ ^ 0n b * l ™ een the program and the child’s
teacher helps to nrevem -. 1 , V P art °f the Re ED program The liaison

has left and to optimize condition's 7 Ch '’ d fr ° m the SyStem that ^
when he is ready Another ° r blS return to a regular classroom

IS the social worker who. h^ttoTh,”’ profess,ona l m the Re ED program
ecological unit such as the fa i 1SOn teacller » deals with aspects of the
als who may be able to heln^l ** COm ™ unUy agencies, and any individu

sonnel in Je Re ED prom m h '7 “’ Ch ' !d The th ™ *P“ o£ **
tit program, therefore, combine to influence all s.gn.fi

INNOVATIVE COMMUNITY PROCRAMS SPONSORED BY MENTAL HEALTH CENTERS / 15

The Day Hospital

The day hospital originated in Russia in 1933 as a facility to which pa-
t ients came during t he day for a full range of treatment programs. During
the 1940s similar institutions were established in Canada and Great Brit-
ain, and by the late 1940s they began to appear in the United States in
private institutions such as the Yale Psychiatric Clinic and the Menninger
Clinic. Since 1950 more than 150 programs of this kind have developed
throughout the country.

T he rationale fo r the day hospital is that it provides relief for the acute
shortage of hospital beds . Frequently patients are discharged from hospi-
t als before the yare quite ready because their bed is needed for the more
acutely^isturbed.The day hospital provides a gradual transition from in-
stitutional to community life. In addition, the day hospital has been used
for screening patients. By admitting a seriously disturbe patient to e
day hospital it becomes possible to observe him over long s ®
and thus to make a better judgment regarding the necessity or

"“in'addki^jojreducing treatment cot, because they
tqnaeUndmre.lessjtXEensive, day to a mental

treated-in a dayjiqspjtal_are spared 'he sh - ents and are main .

tnstiuuien^avoid_being_stigmattzed as men ^ , hey wi n b e

tained in their home environment making {, likplv to

t ibandonedhn iTHdFBniily. Furthermore, ^TliL
be included in the treatment program r

; that he is less likely to become
treatment helps to edu-

overly dependent on the institution. Finally, day^

cate the community concerning psychological ao^-^ 0 utside of a 24-
strates that even the seriously disturbed can be treate
hour hospital.

The Nigh, Hospital . „ a r t .ime hospitalization

Like the day hospital, the night os P* hdng the patient jvho has
ility. It ser ve s tw> typ _gsjjLP-^- entS ' . may find the step from the

gady. undergone, hospitalization (Q [ake a ii a t once. The nig t

mital to the community too bur rnmmunity while it pr

- hospital, the night the patient who has

ility. It ser ve s tYLO typ _gsjjLP-^ entS ' . may find the step from the

;ady^undg^one_ hospitalization tQ [ake a ii a t once. The mg t

pital to th e community too bin community while it pr

pital allows him to establish h,mse ogram s that supported him

es the shelter and many of the trea . ht hospital diminishes t ic

the hospital. For this type of P a ““ . The second

dihood of a need for a quick readnmston. & ^ disturbed in d,i ? dual
p_benefits.greatly_fromjhe,mgh P hospital was design

o is stillxapablc-of working. Ong>nally*e ^ ^ (he expectation

the” early 1950s in Great Britain (B.erer,

74 / community programs for traditional problems

their role as students, were less disruptive, suffered fewer feelings of per-
sonal distress, were able to face new situations, had better work habits,
and related better to other children.

Despite these impressive changes following the Re-ED program, the
question remained as to whether it was the content of the program itself
or the mere passage of time that accounted for the change. To deal with
this issue, Weinstein (personal communication) identified a sample of
disturbed children similar to those in the Re-ED program with the help
of teachers in schools where referrals had been made to Re-ED. These
children had remained within the school system with no special treat-
ment. By using the same instruments on which Re-ED children were
evaluated, teachers rated this control group on three occasions: at the
time the children were selected, and again one and two years later. The
results indicated that the untreated children had remained either substan-
tially the same with the passage of time or had become significantly
worse. °

MENTM^Htrit 1TO M UN rTY PROGRAMS sponsored by
mental health centers and hospitals

J’ reatmetu programs emphasizing the importance

peared in recent ° f ' he mCntal patient haVC ^

grams points out ,t,„ ' . > ' ho on gmated many of these pro-

disturbed are verv n M Coalm i urut i' approaches to treating the mentally
dale back to Ecvmian t™ '' _ Gccu P al i° n al and recreational therapies
and good dieffor he Gr <^ prescribed useful work, music,

any kind. Galen the famous^ 133 ' 1 '™! 3 " 11 Were °PP osed to restraints of

•lent’, family a" ‘S/rr naT" a,te ”P“ d '° trcat the pa ’

the colony of Glieel in Belo P M ° re reccmI y the establishment of

ty effort ,0 deal witl men, ‘Z “ ^ f amp ' e of a remarkable common!-
Gheel was built a! a sfoZto ^ the h ° spital ,**

voted her life to God At her 30 Insh P rincess who had de ‘

other prospective wives, proZd^ dealh ’ falher ' satisfied **
She fled from him in panic, and he marria S e Dymphna.

Gheel and killing Iter when she ret ollowed . catching up with her in
orally hundreds of years children and ad°i 8 °l? l0n8 "" th his P ,an ’ For '‘‘i
for treatment and have been boarded .“It! haVe been brou g h t to Gheel
played a central role in the treatment ”* the local far mers who have
grams sve describe, therefore are shunt™ 8 ” 1 "' Many of the modern P m
community efforts that h,™ t „ ply curTcn t versions of a variety of
disturbed. C C ™ made ■" the past to treat the mentally

INNOVATIVE COMMUNITY PROGRAMS SPONSORED BY MENTAL HEALTH CENTERS / 77

Aftercare Services

Many hospitals are instituting after care services as a means of lower-
ing the readmi ssion rat e- T hese services include various kinds of follow-
u p care for the newly discharged mental patient. One approach is to work
th rough the family do ctor who is brought into the case as an active mem-
berjjf.the treatmentjeam. This is particularly effective when the doctor
h as had a close relationship with the family .before the patient entered the
hospital. A second approach to aftercare involves enlisting the coopera-
tiop jaf visiting nurses associations, or the public health nurses in the pa-
tier\&_neighborhood. Through collaboration with the personnel of a hos-
pital or clinic, s uch nurs es can extend the type of care that they offer to
include assistance to those with mental disorders. They visit homes on a
reg ular basis, ob serve the patient's progress, and can consult with clinic
or hospital . personnel . Continued supervision by the mental health facility
i s an essen tial feature of this type of aftercare program. M

An aftercare program can involve establishing sate ite c "
populous sections of the city. Ideally clinics of this in are s a
personnel who have treated the ex-patient in the ospita . 1 _ -

a pproach to aftercare isjhrough.an active socilLwork-pro^ ^

tel£ ^isi tsjire..m ade_by. psychiatric social wor ers a ia ^ trained

sjitutions in which the patient has been hospitalize . nnt „ vt

mental~health~worker into contact with the patten. « h horn' com *
where .impact can be made on the family and the en.tre envtronmen
around him.

Ex-patient Clubs .

Clubs for former mental patients began to be formed m New _

City in the late ,940s. ujSZ* ^f"?^
the country since that time to serve a variety ^ oJter j, 0 me placements,
tal patient. ThejiatjernpUoJind jobs, ,0 * 1 ^ ditioI)i 10 olfer a recrea-
tp.provide_£ducational ..opportunities anc ' of pI . 0 blems. For many

tipnal.outIet,as-well-as consultation for a cas ing them back into so-
patients these clubs serve the useful putp° , j [( . r G f an understand-

cial relationships and community life mtlun the
ing, helpful social organization.

, • Promams wid. Key Community Care

Educational and Consultation Programs

Rivers by a variety of men-

Another service being extended to “” u i,ation with individuals in
tal health centers and hospitals into v ro f e5 sional role, come into
the community who, by virtue o t ei

76 / community programs for traditional problems

that it would reduce the number of lost working days due to mental dis-
order.

Many night hospitals offer a variety of treatment programs between 6
and 10 or 11 pm. Beds are also available for an occasional overnight
stay. Specific types of treatment services vary from facility to facility.

Foster Home Care

The idea of placing mental patients in the care of foster families ofi gi*
nated, as indicated above, many centuries ago in Gheel, Belgium.'' Over
the years it has been adopted in a variety of countries such as Norway,
for example, where almost one half of the country’s mentally disturbed
patients live with foster families. The growth of the family care plan in
the United States has been relatively slow. However, many Veterans Ad-
ministration hospitals are now moving in this direction.

Foster home care is thought to have a variety of potential benefits.
I ~-- e ^‘^in a f° ster family setting is i nevita bly more like normal li v-
jng t anj t e on a mental hospital ward. In addition St is less expensi ve
cLZE. pe u SOnnd ’ th ^ a iLeHU s not subj ected_to_th&-Q^ r '
iustmp f ♦ * u yp ~ es ho -?P ltal hfeJndj\proyides an opjortunityforad-
unwillitiff °t 1 1C comn ? un ^ patients whose own families are unableor
house w W a '- e . P -^ I ® F ° r many Parents it also represeruT^lfway

they are thrmt ^ capacity to ad J ust in the community is tested before
they are thrust out entirely on their own. ' "

Home Treatment Services

prltaaSrstTyeiTs ubT ° • has existed in Ho,Iand £or ^

and treat the mentiti .'""r"’ 3 ' ava dable 24_hours a day to_eyaiS ate
"■as originally created^tomT''' 1 i!” l£lg ‘- own homes. Home tre atmen t
for help is resnomleH . the ^^Th^ital beds. ThTcail

Most treatment involve S °° n ™ P os sible and visits usually are short.

^ and ’ in H ° 1,and ' n0 psy
Iislied such as one set'u^n m? 7 °™ e „ treatment services have been estab-

portisc psychotherapy as well asdrnv .T 0 ”' In the B ° S1 ° n P ro S ram ' SUp
A numltcr of patients yvlto m ,i,i S lre a <ment are fundamental features

*SSJ found toV treatlble ^rho Je r ri ' y ^ Ve -q--d.hospitalira.ion

that at least one half of ,h^ C 'I r r m .. thi , S , CX P C " e "-- it h e5t!maK ,‘ J
izcd can be treated in ™,ri» w °nld ordinarily be hospital

ice program is that it provides P «^Sf n °* er - feature - o£ the
community psychiatry and nsvcholnvfir ™ portai “ I-H2H1S E™HES > n
ment it is possible to annreri?,J.. ^ J ' r ' hemiore ’ throu S h home trc: “'
patient's illness, and toTnlist tile ° f ‘ he famil y’ s - r . n l e J- n -i- C

y in the overall treatment program-

REFERENCES / 79

References

Beck, J G, Kantor, D, &. Gelmeau, V A Followup study of chronic psjchotic
patients “treated’' by college case aid volunteers American Journal of
Psychiatry, 1963, 120, 269-271

Becker, A, Murphy, N M, 8. Greenblatt, M Recent advances in community
psychiatry New England Journal of Medicine, 1965 272, 621-626 674-679
Beliak, L The comprehensive community psychiatry program at City Hospital
In L Beliak (Ed ) , Handbook of community psychiatry and community
mental health. New York Grune &. Stratton, 1964 Pp 144-165
Bierer, J The Marlborough experiment In L Beliak (Ed), Handbook of
community psychiatry and community mental health New York Grune 8.
Stratton, 1964 Pp 221-247

Donahue, G T A school district program for schizophrenic, or ^ n ‘ c - * nd
seriously disturbed children In E L Cowen E. A Gardner, an a.

(Eds), Emergent approaches to mental health problems New York
Appleton Century Crofts 1967 Pp 369-386
Donahue, G T , &. Nichtem, S Teaching the troubled child New or ree
Press. 1965 . . . „

Cotan. S E , Bneter, D E , «. Magoon T M A M J-*™" “

evaluation of mental health counselors Psyc ot erapy, ' . »

Greenblatt, M A role for the toluntary oiganuations in e wor (n “ uMn j a
health institutions In College student comp* n ™ f J & Conn State
the social rehabilitation of the mentally ill Hartlord uo
Department of Mental Health 1962 Pp 19- i ncnr ,i stratecies

Hobbs. N Helping disturbed children psychologual and ecological stra.eg,

American Psychologist, 1966, 21, 1105-1 H5 sibility In J W Carter,

Hobbs, N Reeducation, reality, and community community mental

Jr (Ed), Research contributions from psy &

York Behavioral Publications Inc, 1968 P P

health New
Holzberg, J D , Gewirtz, H

moral judgment and

& EbnCr - ^r^'of companio-n^.*

self acceptance in of Consulting Psychology, »«. W

hospitalized mental patients
299-303 o[ college students and

Holzberg J D , 8. Knapp, R H Tl ^J°°^n"]o^mal of Orthopsychiatry, I9(h.
chronically ill ment h patients A
35, 487-492

Holzberg, J D , Knapp, R H . S. ^ s'-sniner r. »*» — ~ • _ -

the mentally .11 In E. L. Cossen, E A rd • App iMon-CentutyCro ( s
approaches to mental health problems New

1967 Pp 91-109 a , ronl c patient, and a college

Holzberg. j D , Whiting. H S -ft^2 ut ,, 1964, U, '5 2 ' 158
companion program htenla P

, I College students as companions to
i. Turner, J L. College Emergent

E A. Gardner, »l “ ' _ r-_r„

78 / community programs for traditional problems

tact with many individuals suffering psychological disturbance. Promi-
nent among these are clergymen who are probably more often consulted
by people with psychological disturbance than is any other professional
group including mental health workers. Other professional groups con-
tacting many individuals with emotional problems arc the police, lawyers,
and general medical practitioners. A variety of services has been extend-
ed to these professional groups, ranging from highly structured course of-
ferings to consultation services with respect to the specific problems dealt
with from day to day.

CONCLUSION

A broad spectrum of approaches have been developed in recent years to
eal with community forces believed to be significant in the etiology of
mental disorders, and to better use community forces in treatment. These
approaches range from training new manpower sources to perform highly
traditional functions, through using well-intentioned but relatively un-
tamed people to develop beneficial relations with the mentally disturbed,

0 interceding in the community itself to make it a healthier place for

1 ‘ S ^ enng u mental disorders * Ma "V of those community programs are

comnrph ^ types ° f instituti °ns (e.g., the Re-ED school and
“ P tT' e co ™ n »ni‘y mental health centers), but some arc simply
schocHand me „ U , n at"os p i, n a,;: l°"f>“ hed -tings (e.g., the public
to estahUshpd ™ • P ,. T ‘. ’ In addlt,on » soi ne programs have few ties

proems indicar C, T ‘ hdr ’° CUS OT ’P"ip, all of these

mental disorder a ? m ° re com P reIle nstve conception o£ what causes
mental dtsorder and what can be done to treat it than has ever been held

tions as P weU a ™ S to 1 «tabU s h Pr ne miS f '° reshape P 13 "? traditional institu-
they are brineine to f ™ f° rms °* service agencies. In addition
-the nonprtffessionah C This develonme U " heard ° £ type of service worker
lems and consequences many of .!"? Cames w,th !t a train o£ P rob ‘
chapters. One obvious consem l 11 * are elaborated on in succeeding
appearance of nonprofession^lshTve 1 . mportant implications that the
moved from the front rank nf ■ f ° r the role o£ th e professional. Re-
come a program organizer, recruher' aain^' pro£essionaI muS ‘ be '
fessionals. The prospects for what can be n and u supervisor o£ nonpn>
most exciting, but require that e " b done throu gh such roles are
learn ways ol functioning very different"™ m “ taI , health Passionals
tomed to, and that traininv nrnorn™ r & What they have becn accUS '
count these new role requirement * P rofess i°nals take into ac-

4- restructuring the
hospital community

, r „„„ laeeed behind in the
Interestingly, mental hospitals, which or ™ were ,he site ol some ot
development of advanced treatment a P p ’ comm unity forces The

the earliest patient care programs emp ear j y ]9th centuries, men

humanitarian reformers of the late 1 1 j to benefit patients

like Phillipe Pinel and William u e { enuronment The} re

by making fundamental changes in e £ ree j 0 ms tint made hos-
moved physical restraints and intro “ they enC0 uraged kind

pital life more like life outside n a j los «ital personnel, attitudes
ness and understanding on the par

that they believed would be therapeutic partlC ularly in the Unit
Hospital reforms were y iq a , . £ n tury where an approach no^n

States during the first half of t ie .057) pre\ailed Bockoven poi
as moral treatment (Bochoven, ' ten ded to come) bot i t i
out that the term moral treatmen '' . ance their moral ng i
that the insane must be treated in SI

80 / community programs for traditional problems

Kantor, D Impact o£ college students on chrome mental patients and on the
organization of the mental hospital In College student companion program
contribution to the social rehabilitation of the mentally ill Hartford, Conn
Conn State Department of Mental Health, 1962 Pp 28-38
Kantor, D , &. Greenblatt, M Wellmet halfway to community rehabilitation
Mental Hospital , 1962, 146-152

Klein, W L , & Zax, M The use of a hospital volunteer program in the teaching
of abnormal psychology Journal of Social Psychology , 1965, 65, 155-165
Lewis, W W Project Re ED educational inters ention in discordant child
rearing systems In E L Cowen, E A Gardner, & M Zax (Eds ) , Emergent
approaches to mental health problems New York Appleton Century Crofts,
1967 Pp 352-368

Magoon, T M , 8. Golann, S Nontraditionally trained women as mental health
counselors/psychotherapists Personnel and Guidance Journal, 1966, 44,
788-793

Poser, E G The effect of therapist training on group therapeutic outcome
Journal of Consulting Psychology, 1966, 30, 283-289
Rappaport, J , Chinsky, J M , 8. Cowen, E L Innovations in helping chronic
patients New York Academic Press, 1971
Rioch, Margaret J Pilot projects in training mental health counselors In E L
Cowen, E A Gardner, & M Zax (Eds), Emergent approaches to mental
health problems New York Appleton Century Crofts, 1967 Pp 110-127
Rioch Margaret J , Hikes, C , Flint, A A , Usdansky, B S, Newman, R G, ft
Sober, E National Institute of Mental Health pilot study in training of
“ e “ a * health couns ei°rs American Journal of Orthopsychiatry, 1963, 33.

Umbarger, C C , Dalsimer, J S , Mormon, A P , and Breggin, P R College
Students in a mental hospital New York Grune and Stratton, 1962

ein, Laura Project Re ED schools for emotionally disturbed children

ceOliotuiTrii M vlewetl b I String agencies, parents and teachers Ex
ceptional Chtldren, 1969 35, 703-7 U r

Weinstein Laura, Personal Communication, 1970

RESTRUCTURING THE HOSPITAL COMMUNITY / 83

behavior, on discharge all but one pseudopatient was diagnosed as being
a schizophrenic in remission.

One reason for staff failure to recognize the pseudopatients’ sanity
seemecf to be that the staff had extraordinarily little contact with patients.
Attendents spent an average of only 11.3 percent of their time outside of
the ward staff station; daytime nurses emerged from the staff station only
11.5 times per shift (including times when they left the ward entirely);
and physicians appeared on the ward an average of only 6.7 times per
day. Staff appearances on the ward were primarily for caretaking ad-
ministering medication, conducting a group meeting, or instructing or re-
primanding a patient. Direct questions or requests of staff by pseudopa-
tients generally drew brief responses, while the staff member was on the

move," or no response at all.

Many examples are given of hospital practices and encounters wit
staff that prompt a sense of depersonalization and powerlessness in the
patient. Included among these is the fact that the eight pseu opatients
were administered nearly 2100 pills (representing severa i eren
drugs) , while only actually swallowing wo of them. e remain
pocketed or flushed in the toilet where the medications of other pat tents
were often found. Occasional instances of unprovoked harsh or even bru
tal behavior on the part of staff also contributed to > fed.* of£>wer
lessness and depersonalization. At times, that ec ing Having to

portions as to nSTke the patient fee!

submit to physical examination in a sem p extreme in

and going is one example of an incident prompting such an extrem

The experiences of Rosenhan and his , fcllow “’^^“pirh of the
awing taken by the modern mentd ^"dwmeL the degree to which
moral treatment institution. 1 ms siu y - mDers0 nal, custodial institu-
te average mental hospital has become an i ^ *< our overwhelm-
tion, despite the fact that Rosenhan can say cared, who were com-

ing impression of them was of people who really ca

mitted and who were uncommonly intelligcn. ^ ^ mora l treatment,

Several factors probably account for tne . ircd leaders of the
not least of which is the fact that man ' t]ienl yj, e successful practi-
movement passed on with no one to rep disciples who could carry on
doners of moral treatment trained very infusion into American

their work. Another significant factor . " of lhc day that mental duor-

psychiatry of the dominant European rcJ _, r ded as a brain disease,

der was physiologically based. I'” an .^'“ c Xged by experience will,
usually degenerative. This viewpoint ^ work suggested "batmen-

large numbers of paretic patients, an , minatin g die unfit from
tal illness was one of nature s ways

THE THERAPEUTIC COMMUNITY / 85

and practices of general medicine, traditional mental hospitals were fail
ing to meet the needs of psychiatric patients In his own words

“Psychiatry has, in my opinion, paid far too much attention to the
model created by general medicine This is inevitable so long as doctors,
nurses, and other professionals associated with psychiatry take their un-
dergraduate training in general hospitals, whose social organization ts
geared more to the needs of surgery than of psychiatry The omnipotence
of the medical leader, the absence of two way communication, and the
rigidly defined status differentiation, which often excludes the patient or
a person, are only a few of the extreme characteristics of this setting

(Jones, 1968, p 126)

For Jones, as for Sullivan before him, the most significant force in treat
mg and preventing mental illness is the social environment, and it is pre
cisely that force on which traditional hospital structures fail to capita ’* e
Therefore, Jones set out to create an environment within which all of the
patients' hospital time would be therapeutic In line with t ese goat. e
hospital was regarded as a microcosm of the larger community: aro
Jones' innovative program had as its immediate forebear '
field Experiment' In 1943, two English physicians. Bion and Rictona ,
were sent to the Northfield Military Hospital to rotore : or** m one sec
turn of the institution after conditions there tad become unruly,
(Kraupl Taylor, 1958) They went about the “ J, Return to c.
patients, who chafed at Army discipline and „ mmU nity life The

Vihan life, the responsibility for managing teir own authonty

doctors in charge of the hospital "*nq n , iving m a chaottcal

and let the men know that their choice v themselves into a structure

ly unstructured community or organizing! removed the Army

with which they could be comfortable This practice remo
as a convenient scapegoat when things went I ^ tc | cjna n ncr e eventuall)

The administrative innovations of Bion an ^ j e stimulated the
extended to the entire Northfield ** 0S P lta -, DD roaches to behavioral
development in England of a variety o gro

problems directed not toward psjchotics

Jones first therapeutic community w disorders who suffered ex

but toward chronic neurotics an c ar , tmen ts These included ps>
tremely poor social and occupational ad] ^ scxual perverts, all
chopaths, schizoid personalities drug a . thfficult to treat Jones
sufferers of disorders that have been n0 jividuals and therefore, «*

e arly patients were hard core unemployed 'U.^ Qf Labor am

program was supported by the n /l) to stud) the

Pension The project had five d,stl ” tQ re nder appropriate pt> 11
characteristics of the patient group, { )

84 / restructuring the hospital community

man species. In essence, the mentally ill were viewed as lacking the at-
tributes that typify a human being.

As this viewpoint took hold, hospital statistics were reexamined and
reports of improvement and cures were questioned. Bockoven has de-
tailed these efforts and has pointed out obvious weaknesses in the rea-
soning of those disputing the worth of moral treatment. Nonetheless, such
criticisms were accepted in their time, and gradually hospitals grew in
size with less and less money being devoted to patient care and fewer and
fewer physicians choosing to work in these custodial settings. The mental
patient was no longer regarded as a member of his physician’s family. In-
stead, he was an inmate of a “prison-asylum.” Institutional life was re-
duced to a meaningless empty routine. Maintaining the patient's life be-
came the main purpose of the institution because neither the laws nor
medical ethics permitted ending it. Within the hospital the patient re-
tained only the right to live. It took nearly a hundred years before wide-
spread efforts were made to revive moral treatment approaches.

THE THERAPEUTIC COMMUNITY

An early example of a return to a program akin to moral treatment was
described in 1930 by Harry Stack Sullivan, who attempted to create an

loin x/ reatmCnt e ™ ronment for the acu te schizophrenic (Sullivan,
31). He set up a six-bed ward detached from all hospital services ex-
cept ‘hose devoted to occupational rehabilitation and recreation. In par-
the trad ‘tmnal nursing service was eliminated. Sullivan stressed
rather ’ f h mental h °, S . pUal raust become "a school for personality growth,
schtnnh “ a oE personality failures," and held strongly that the

emelv T„',V gI0Wtt ! rould «»* 1* facilitated by people who are ex-
raS doctor i° interpersonal needs and fears Traditionally
t e blumed h “I nUrSe -’ hC MieVed ' have their interpersonal sensitivi-
ea, mem atm mT T'™*' Sulliva "' therefore, used as his primary
^ a ** intuitive grasp of what
some Dotential , t, - a 1 ke ' P ossl bly because they themselves had
tt seen att u,- T" 8 schizop hrenic. These therapeutic agents

undeveloped tend n ® ‘ n growth b y experience of a body of relatively
tumdon broadt 5 relations; the situation is one of

" 0t ^ V6rbal but by communal

livanTtsTv a " d h*"- 1 ™'™ innovative hospital progntm than Sul-
Jones emba bed t JUSt “ ^ War 11 b >' MaJtSjTes (1953).

atu ictmtfn , "Z V f n ‘ Ure !n h ° Spital treatment, called the "ther-
peutte communtty, w.th tlte conv.ction that, in adopting the principles

good boy. When the others had gone the son sat reading for a while and
then, on looking up, noticed his mothers purse and helped himself to half a
crown Then the family returned tired but pleased after a successful trip The
mother needed some money, took her purse and noticed with surprise that
half-a-crown was missing She asked the girls if they knew anything about it but
they did not, however, they told the mother that their brother had remarked

recently that he needed some money The son immediately denied having opened
his mother's purse The psychiatrist now turned to the audience and asked for
comments It was suggested that the son was resentful because the family left
him alone, also that the sisters were trying to exclude him from the family
group and would be glad to incriminate him in the theft, etc Eventually, Mr M
suggested that the son (played by the psychiatrist) should confess He went to
the family to confess, but in fact he did not This provoked consideration of the
difficulty (n any confession and the audience seemed to warm up Someone
suggested that the mother was a difficult person who by forcing a goo toe
on her son made it difficult for him to confess Some patients e 1 1 at if w°u
be best to confess, but others disagreed Mr M suggested t at t e son s ou
put the money back without anybody knowing This was t en acte °
was demonstrated thot the sisters' suspicion persisted ond t e am y
relied The audience again discussed why It was difficu t to con e _ ^ Thls
advised to try and mate the mother's attitude towar s im bought and
was acted out. the son telling her that he was not so good as she thought, ^
pointing out that her attitude made everyone expect °® 0 j ror ,f e ssing

annoyed his sisters The son then appeared to e on . now par .

when he broke off and turned to the audience e con f ess this seemed to
ticipatmg freely at a feeling level and urged t e son ^ ^ now returned to
be clearly the feeling of the community as a w o e demonstrated and

the family and confessed, and the family's rea confessed suspicion

discussed Some patients pointed out that untr „ which was

. .M. thora fintll

tniei ■

e from the word which was

ogmu puiicms — -- nme from tn e waru

would tend to fall on the innocent These patien s c bac j p| a y e d the role of
associated with the recent thefts The psyc ' atn * . j , n our midst had been
the son) now summed up and pointed out t a _j ess seemed to be the

asked to play the difficult role of the confessor, n ^ w hich the "famil/

only constructive thing for him to do an t e ® confession had been ma e
tension could be eased He pointed out a ^ ^g "good boy
more difficult because the son had been oo were "bad boys" and wer

pointed out the difficulty of confession for t o

expected to do wrong /or vone felt that the au ienC ® ,

At the 9 45 A M. meeting of the staff e <7 ^ q pub , |C confession
wanted the thief to confess, but it was o iso ^ concerned, also » ° *

kind would be extremely difficult for the p h , afr ,st felt tha

would be difficult to obtain or participation and their

achieved his objective in obtaining t e

86 / restructuring the hospital community

care, (3) to find what job would be best for each patient, (4) to pave the
way for the patient s to return to the community, and (5) to followup pa
tients to evaluate long range program effects

A basic feature in the therapeutic community is the assignment of each
patient to a job that he is expected to perform faithfully In the selection
of employment, primary emphasis is placed on semiskilled jobs, which
are plentiful in the community surrounding the hospital, instead of on
training patients for high level trades Also patients are not permitted to
make things for themselves but, rather, are expected to produce things
that will be of social value

Another basic element of the therapeutic community is a daily one
iour morning meeting for all patients and as many staff as can attend In
Jones ear y program the content of this meeting varied with the day of
, Wee n ondays a session was held where patients might

in? SUgg f tl0ns re g ardin g the program The Tuesday meet

problem yP1< H y n dldactlc one in which films on job training, social
meetings' ^ re *? hl ’ ltatl0n were viewed Wednesday and Thursday
be of currl? * ed d ' SCUSS,ons o£ *>™l°g.cal problems deemed to
parmers^ 1° **** S™'P S £ ° r “*4*. "should married

er? Such disc ” S '° U ' d Ulsband and Wlfe spend leisure time togeih
n erest ,ntr : 0n f,T e im<mdcd st 'mulate and encourage patients
“m" 7Z , d f T ° £Unher ,hls e " d - Paving and psy
mg an issue Frida T * enCVer they 5ee med appropriate for dramatiz
which a problem or situamnW were devoted to psychodrama sessions in
depicted The patients th " T™ the paSt llfe o£ a P artlcular patient was
sions, wrote a play to d TCS voIunte ered the content of such ses

Half hour prese„uuomw“ I and chose a cast to dramatize it
to the hospital followed bya' a p ' ended b y aI1 Patients, stall, and visitors
non A deLption oTa 4 „„ P yS ' C,and,reCted of the produc

of some money well charfcter,zrthe^mm.ngf re 0 £olIow,ng the thrft

For this meeting it was decided n

felt that the difficulty in , 9a ' n f ° Use a P ro l e ction technique It was

only treat the individual concerned ° U H d **1 fllsh ' lghted as otherwise we could
community In Irec ^y as an unknown member of the

A family scene was enacted with the „„ t .
os the mother, and two nurses as th P 5 y c,llalns t as the son, the Unit Sister
was a holiday they should ao f 6 Tbe mo,her suggested that as it

behind as hewasna w no IV/^h ^ "" S °" «"*"»» *> ba

---er pra ,se dhlm r^rs^^:-^^

TIIE THERAPEUTIC COMMUNITY f 89

ity who mediates quarrels between patients, and reports moderately se-
vere patient infractions. I-Ier second, and perhaps most important role is a
social one. She is expected to become acquainted with each patient and
to spend time with them according to their individual needs. In so doing,
she is required to guard against using relationships to satisfy personal
needs by spending time with those she likes rather than with those who
need her most. Finally, the nurse has a therapeutic role requiring her to
“interpret or transmit the unit culture to the patient" rather than becom-
ing involved in a one-to-one relationship. The more she absorbs and ac-
cepts the culture, the better she is at stimulating patients to take part in
the social, occupational, and special activities of the community.

The doctor in Jones’ therapeutic community consciously dissociates
himself from the role of remote magician thrust on him by society. He ac-
complishes this partly by avoiding many of the trappings o t e
doctor in tlie typical hospital-the white coat, the stethoscope and per-
cussion hammer protruding from ^ ™ t a

peuttc community has five components, hirst, I* - j v, e

soda, role that he fulfills by c^tfona!
supports and encourages patterns who ' f . where he

progress. Third, he participates m danger of others

serves as an example of one who can face P_ Fourt h, he encour-

without losing his own control or having , somet j m es uses

ages patients fo deal actively with their ™ in '

psychodrama to allow them to try out for many o£ their feel-

terprets for patients the significance of a

ings and behaviors. . . . t 0 a disciplinarian. In

In the therapeutic community the p yst 1 ^ {Jie ru j es 0 f the culture

this role he attempts to convey the lmpor an untostand why infractions
and, together with the patient, he ists despite these efforts,

have been committed. When rule tea doctor takes such ac-

discharge from the community is consi , j nV olved with the pa-

tion only after considerable discussion w topic for one of the dai-

tient, and invariably such discharges ser\

ly discussion groups. .heraneutic community are much

Doctor-nurse relationship in the ,, osp j [a l. The staff eat together
more informal than they are in the typ n am e basis wit h nurses, al-

regularly and generally doctors are o . u | ar j y in the presence of outsi-
though the title "Doctor" is reta, "' :d , I to a review of doctor-nurse
ders. Staff meetings are continually a

relations and, at times, arouse considerable te fa , therapeutic com-
Jones (1968) has stressed that the „f all patients and

munity is "to make optimal use insofar as possible, the join
staff." Therefore, decision making is.

pressed need to hove a confession in order to relieve the family tension At this
point he thought it might be better on future occasions to let a patient, or several
patients, playing the part of the son, do the confessing Such acting out might
have established a pattern of behavior and made it easier for the real thief to
confess Moreover, he thought that the family should have received the con-
fession with relief and brought out some underlying motives for the theft so that
t e idea of understanding and "treatment" rather than punishment was stressed
is ad not been done because the family scene had only been roughly
sketched with the staff before the 9 A M meeting and there had been no
actual rehearsal or elaboration of a definite goal
One therapeutic group discussed the 9 A M meeting spontaneously They
e sorry or t e boy who was left behind when the family went to the seaside
llul kflt gr0Up L te " ded to ^proach the family for the son's theft One patient
■ , Son had stolen ,n order ^ get more attention from his family Nurse

“ 7 j 0 ™: explanat,on might apply to the individual who had stolen
feel th'rutk 0 S S WQS dlscussed at length and it was felt that the culprit might
disturb t e community here was too permissive and nice, and had wanted to
disturb .t or to attract attention to h.mself

and n s a!d e thatth P ft, 7®? the t0p,C ° f the 9 A M meeting spontaneously,
fession but foil Hi t A# eve ° P6d a good understar idmg of the reasons for con
personally waived ' ^ ' '° P ' C ’ Ure ' hereo,ves doing this if they were

Two groups declined to discuss the 9 A M meeting

"' em ‘ A Gr °“ P Meetms m ,he Therapeutic Community yones. 1953, p

172)

therapeutic community has a few fr h * actlvlt,es - the P atlent in th<
leaving the hospital if he is well h ° Urs each day Wlth the °P tlon
p M each day, organized social nr en ° Ugh to do 50 Finally, from 7 to !
mittee These mclude concert, arranged by a patient com
play reading groups * nces ’ danci ng classes, art classes, anc

the typical mental hospmd are d,fferent £rom those in
nurse, but only a few have had ? CSt St3 ^ S 1011 ? carries the title ol

group of trained nurses is respons.bTe fT 1131 T'' ttaInm g The smaI '

remainder are typically young Eir |. car ' ng for the physically ill The
planning social work careers In To ■ soclal science degrees or girls
ans Their foreign origin seemed >,? eS P 10 ® 1311 * many were Scandinavi

pauents who commonly considered them^elve^™ m ° re a PP roachable f ° r

The new nurse is placed on the ™ n as outsiders
training and is expected to have three' '1 Z ' '‘ bout re ce ,v m g any special

J r roles First, she is an author-

THE MASSACHUSETTS MENTAL HEALTH CENTER PROGRAM / 91

r characterized by having the patient come to an old office
the hospital, where he was received in a bare, undecorated
dmissions officer who asked a series of abrupt, impersonal
>m there patients, sometimes manacled, were taken to a se-
n of the ward through back stairs. Typically they were
ie, their clothing was removed, and they were deprived of
articles as eyeglasses, dentures, money, and jewelry. Small
iew patients, already disturbed, developed an additional set
lated by the institution itself. Therefore, the new program
he admissions procedure to make it more tolerable. Admis-
mishings were made more attractive, admitting personnel
d to take more time with the admissions procedure, female
nurses were assigned to take the patient to the ward with a
- nt in the background. Once on the ward, the patient seas
•anted to take a bath. He seas allowed to keep his osvn do-
rsonal possessions, and he was shown _ around his new sur-
_ i instructed in the use of available facilities.

Within the hospital itself a number of procedures that presu™ Uyl had

been instituted as security measures underwent senous ^ ^

. , . . u nr i- 0 f the ward, a commonplace at uie

ample, seclusion rooms at the b»U by nndo[hEd> hostile,

time the program was set up, 0 ? m J t . Most patients ro

or withdrawn patients, living in Hieir o overpowered physi-

sisted being put in seclusion so tha '' Arough the wards, an unnerving

tally and dragged, kicking and screaming. ^ ^ hospi[a , pro .

procedure for personnel and other P use c f seclusion rooms

gram a concerted effort was made o ^ successfully achieved

as well as lesser forms of restrain . . . tors ass erted that the

through several means. First, * minishe d, and they encouraged

practice of secluding patients cou tJiat man y disturbances dis-

ward personnel to do so. It was P° m e . procedures used to manage
played by patients were prompte V an( j jj, at many other institu-
them ratlier than by their menta isor sedus j on an d other restraints,
tions had successfully eliminate t e 11 0 j restra ints was the bring-

A second factor contributing to the re Staff-professional-Ied

ing of ward attendants into the trea whi ch fears and frustrations

group sessions were held for attendanBinJ^de that the attendant must

about the job could be expressed, an are ^ conT eyed. These

he a participant in the planning °‘ wer e essential cogs in the

meetings helped attendants rea 17 disinterested, routine a PP r ° a .
treatment procedure, and their 0 interest in engaging pa

patient care was replaced by a g helped eliminate restr i'

various activities. The thi ?' f3 W 'natien's was that every effort was
method ol dealing with disturbed pat

90 / restructuring the hospital community

ture of all who are involved To facilitate decision making by consensus,
communication at all levels of the therapeutic community is made as
efficient as possible Jones believes that the most important attribute of
the leader in the social community is a capacity to preserve the totality of
the organization while encouraging flexibility, self-examination, social
learning, and change within its members When things are going well,
therefore, he can be relatively uninvolved Thus the phrase that best de
b^h * 6 €aC * €r S r °k In t ^ iera P eutlc community is “leading from

TV done ' SIX momhs after discharge, of the social ad
Overall* nd ° * e patients m Jones' original therapeutic community
formni ]us ment was measured by combining 11 indexes based on in
rrb and r p ~ denving from S1 * month, followup interviews
tiem’s heahh g , pat,em l Im P ressl0ms t.c measures, judgments of the pa
of living* ’ Va Ue ° n } j* labor market, social adjustment, and standard
number „f davs qUa r1 ed ‘ h /° Ugh rall "S “ al “ Other criteria, such as
Visit average length of !oh * J^V** months - wages earned at tune of
ready quantified w i. , and Saary ln t,le past six months, were al
degree^to which eael? 8 ^ ^ “ h measure were computed based on the
all 11 measures comt u^r l ° 3 general adjustment factor consisting of
tisfactonly and that f ° Und 44 P 01 ™ 11 had adjusted sa

mamder, 34 perc ent Zr TId makmg a fair adjustment The re

in this exjieriment had 1 ' ,US . ,ng poorly Considering that the patients
their livesfthese resuhs Chr ° nlcally maladjusted through much of
of Jones’ «Xe^ S oro ' nC ° Ura f An ° thCT “»re of the success
that is stimulated (FaLvSher* 'l964 n ™ ber ^ h h ° SpUal P r0gramS
and Maynard, 1969, Greenbl-nt ’v i ' Fairw eather, Sanders, Cressler,
Sanders, Smith, and Weinman, 1967)* ’ ^ Bro "' n - 1955 ’ Sanders, 1967,

PROGRAM ACHUSETTS mental HEALTH center
A n innovative hospital program

moral treatment era and to the ther™ 1 ^ b ° th l ° the oId hospital of the
was described m the 1950s by GreenM^ ^. co f munity of Maxwell Jones

report details a senes of changes involve a "d Brown (1955) This
procedure, that was introduced over a ™f.^ rtU , aUyevery of hospital
Mental Health Center CMMHO , “ o£ ^ars in the Massachusetts

Hospital, an institution for the’,^ 7 ‘ he Boston Psychopathic
ance treatment of acute mental distur

Traditional admissions procedures at MMHC n ,,

mml. as well as many other

THE MASSACHUSETTS MENTAL HEALTH CENTER PROCRAM / 91

hospitals were characterized by having the patient come to an old office
at the rear of the hospital, where he was received in a bare, undecorated
room by an admissions officer who asked a series of abrupt, impersonal
questions From there patients, sometimes manacled were taken to a se
elusion section of the ward through back stairs Typically they were
forced to bathe, their clothing was removed, and they were deprived of
such personal articles as eyeglasses dentures, money, and jewelry Small
wonder that new patients, already disturbed, developed an additional set
of fears stimulated by the institution itself Therefore, the new program
restructured the admissions procedure to make it more tolerable Admis-
sions office furnishings were made more attractive, admitting personnel
were instructed to take more time with the admissions procedure, ema e
attendants or nurses were assigned to take the patient to the war wit a
male attendant m the background Once on the ward the patient was
asked if he wanted to take a bath He was allowed to keep his own clo-
thing and personal possessions and he was shown around his new sur
roundings and instructed in the use of available faci ities , ,

Within the hospital itself a number of procedures *at pr umabl^had
been instituted as security measures underwent serious t j, e

ample, seclusion rooms at the back of the war ’ a COm , h d hostile,
„m P e the program was se. up. were

or withdrawn patients, living in their own overpowered physi

sisted being put m seclusion so that they "*^ h the wards P an unnerving

tally and dragged, kicking and screaming S ^ ^ hosplta l pro-

procedure for personnel and °‘ her P duce the use 0 f elusion rooms
gram a concerted effort was made to ^ successfully achieved

as well as lesser forms of restrain ors asse rted that the

through several means First hosP 1 " d a irmnishc[1 and they encouraged
practice of secluding patients cou that roa ny disturbances dis

ward personnel to do so It was po procedures used to manage

played by patients were prompte J ^ ^ many other mstitu
them rather than by their mental aiso luslon an d other restraints

tions had successfully eliminated t e use n of res traints was the bring

A second factor contributing to the re am staff professional led

mg of ward attendants into the treatme w f, ic h fears and frustrations
group sessions were held for atten 5 attitude that the attendant must

about the job could be expressed an care was conveyed These

be a participant in the planning o p ^ were essential cogs m the
meetings helped attendants realize nteres ted, routine approach to

treatment procedure, and their form _ tarp . t in engaging patients m

treatment procedure, and their tonasr m engaging patients in

patient care was replaced by a gen ^iped eliminate restraint as a
various actmt.es The third factor th« ^ ^ every rfort was
method of dealing with disturbed patients

90 / restructuring the hospital community

ture of all who are involved To facilitate decision making by consensus,
communication at all levels of the therapeutic community is made as
efficient as possible Jones believes that the most important attribute of
the leader in the social community is a capacity to preserve the totality of
t e organization while encouraging flexibility, self-examination, social
learning, and change within its members When things are going well,
t ere ore, he can be relatively uninvolved Thus the phrase that best de
b^h ” £ ea£ k f S r °* e 111 iherapeutic community is "leading from

inctm ™ d0ne ' S1X months af ter discharge, of the social ad

Ov I!* o t e patients in Jones’ original therapeutic community

formal 3 * US * ment was measur ed by combining 11 indexes based on in
: f T 2 ‘ °" and ' m P rKS,ons denying from six month, follow up interviews
tiems hllth^ , Pahent l Im P ress >°ms,.c measures, judgment of the pa
of living wcr Va Ue * ab0r s °cial adjustment, and standard

number®^ ZJ ’“ d t 'T’ Ugh ralln S sca, “ Other cntena, ™ch as
Visit, average lenmh C f ln the P ast Slx months, wages earned at tune of
ready quantified w °u J °r 3nd sa ^ ary In P ast six months, were al
degree to which end' ® i* S eaCtl measure were computed based on the
all 1 1 measures coml l ° 1 general adjustment factor consisting of

ttsfactonly and that ^Tuercem* f ° Und ‘ hat U percent had adjusted sa
rnainder 34 perce nt makm S a fair adjustment The re

in this experiment had been JU h'"® P °° rly Considering that the patients
their lives, these results ar ° ronical y maladjusted through much of
of Jones experimental D rn encoura p n S Another measure of the success
'hat is stimulated (Fa.rwSta-’ 5 'ig&TT ^ ° £ hos P Ital pmg 13 ” 15

and Maynard 1969, Greenbhtt v * Fairweather > Sanders, Cressler,
Sanders, Smith and Weinman 1967^ ^ Br ° wn ’ 1955 > Sanders, 1967,

ScS*™”™ ■»»«. HEALTH center

An innovative hospital nr

moral treatment era and to theTh S ' mdar Bo 'h to the old hospital of th
was described in the 1950s by Gr en ^ Ut ' c c °mmunity of Maxwell Jones
report details a series of changes involvmv Y ° r ^ and nrown (1955) Tin
procedure that was introduced over a J Vlrtuall y ev ery aspect of hospita
Mental Health Center fMMHn P^ n °d of years in the Massachusett
Hospital, an institution for the ’ treltaem ^ Boston p sy ch opatlm

Hospital, an msmuuon for the > ’ JeT”’ 5, ^ Boston Psycl
ance the Raiment of acute mental .

Traditional admissions procedures at MMHG » 11

ivuil, as well as many

THE MASSACHUSETTS MENTAL HEALTH CENTER TROCRAM / 93

serve food and clean up afterward and eventually took over this chore al-
together. Meals were leisurely and social. Smoking was encouraged.
Efficient handling of mealtimes became less important to staff than mak-
ing them enjoyable social events.

Another important feature of the MMHC program was patient govern-
ment. This aspect of the program grew out of a survey among patients
concerning hospital living conditions that uncovered many strong nega-
tive feelings and numerous suggestions for change. Several of these
suggestions were discussed with hospital administrators, who took steps
to make appropriate changes. Eventually, the patients on one ward held
meetings concerned with the improvement of living conditions, and this
activity came to be known as patient government. The nurse on this ward
became the representative of the hospital administration to the patient
government. Ultimately the patient government took over housekeeping
functions and the organization of dormitory living. Six mont is a ter t us
procedure was instituted on one ward, it was adopted on anot ler cause
of the favorable patient reaction to the improvements resulting from it
As patient government spread through the hospita , nurses, occupy
therapists, social workers, and psychologists became regu ar '“ SI
meetings. To insure continuing patient government 1" P ■"

w^lfset^u^m^in^g^'l^g^number^o^patients'resp'onsible for the ongoing

collections at annual dances, and use the P r0 su bstnntial amount

rette machines around the hospital, thus acq • observations,

of money. Hospital administrators were satisfied, after some

that this money was used wisely. government to inform the as-

It became a common practice tor p* Meeting of the requests and
sistant superintendent by letter after «“ > A -.point response

points that had been made during tJie patients could sec the

was always made within a week, n 11 Guests. &f a ny felt that the
concrete effects of their deliberations a ( j iat patients found that

most significant effect of patient gosern _},i c G f functioning demo-

they were held in genuine esteem as people capable

cratically toward reasonable ends. efforts were made to max-

In addition to encouraging patient gr p roc otH, r nl rules svere down-
imize the therapeutic potential o f“ initiative, judgment s-as

graded and the use of "intuition, i B c)ianRC s | 10 uhl he accepter at
encouraged. The attitude was stresse | n „h discussion and argu-

a possibility in all cases if it came abm S ^ „cte encour-

mem. All personnel on the hospital hterarC).

92 / restructuring the hospital community

made, once the patient was released, to interest him in some sort o£ diver-
sionary activity. Ordinarily the ambivalent patient released from restraint
feels that he has reentered the hospital with a reputation as a troublemak-
er. If left to flounder in surroundings he feels to be unfamiliar or threat-
ening, his behavior quickly deteriorates again. Therefore, structured ac-
tivities such as games, sports, occupational therapy or work programs
were developed.

Once it was demonstrated that the problem of security was not nearly
so significant as it had been thought earlier, interest shifted toward im-
proving patients’ appearances. It was obviously desirable for patients to
dress in other than the bathrobes, slippers, and heterogeneous apparel or-
inarily provided for them. Efforts were, therefore, made to obtain more
suitable clothing, initially through gifts from the staff and friends and,
eventually, from a variety of unsolicited sources such as the families of
patients themselves. Having better clothing, patients began to show pride
in their appearance, were careful about the way they dressed, and cared
or tieir c othing. Such behavior signified to personnel that patients re-
, “ 1£ - r “pect and prompted still further staff efforts to change
ospital routine so as to encourage further patient growth.

stnff intro f - CX by patients in things that they valued prompted

the heln ofV 1 " S the P hysical environment more attractive. With
“ t 1 “ “ l, ? ns from «l^ves and interested friends of the hos-
the typically dull” P ^ tUres . WCre hung ’ new fur niture was installed, and
were painted in Itn ? nvironraent was brightened considerably. Walls
decorated them with murals °" a " d ' in S ° me rases ’ talented patkntS

on the hospital^waM 1 ” 1113 '' 1 ' 5 desocla,lzation process typically occurring

uvjx ,o promo,e sodai be -

promote socialiVati^r. , MHG program. Recreation equipment to

o^din^; be f^Xn A ”*** “* a " d S" a£ "tight

dents together. The imroduction”oTh CXCell d nt t VeIUCleS £ ° r bringinS p3 '

ograph and piano also promoted socially ^ ™ di ° a ” d IatCr 3 ph °"'
programs, and formed groups to dk Pat,ents selected their own

Other revolutionary move Lolj'd ““ pr0grams o£ s P edal £ " terest - An ‘

together for various activities. The pracdce”® and women patientS

nel who feared that it P actlce was at first resisted by person-

sponses. The result of this practST 1 ho* 6 re ’ eaSe ° £ a SS ressive 56x11:11 re ‘
dent behavior. Men became mm- ’ w . ever - was an improvement in pa-
and women too^ide " “”7°“ ** *“ ““

a variety of evening activities^ X as 7 rtXlT' ^ °

les, lectures, and concerts was still nnofu • ngs ’ s P orts events ' mov ‘
were altered to resemble * j 6r innova tion. Mealtime routines

resemble those practiced in most families. Patients helped

TOE MASSACHUSETTS MENTAL HEALTH CENTER PROGRAM / 95

came to be looked on more as colleagues than ever before In addition,
weekly “classes” were set up for head nurses led by the director of nurs
ing These offered a channel for communicating about all matters related
to the nursing service, for discussing administrative issues, and for griping
about frustrations

Because the entering patient’s anxiety is provoked in large measure by
the hospital’s reputation in its community, and because the support re
ceived by the hospital is also, to some extent, determined by that reputation,
efforts were made to better inform the community about the Massa
chusetts Mental Health Center One direct way of acquainting the com
munity with the hospital was through the friends of hospital employees
Unfortunately, for many years most attendants, nurses, an resi ents
lived in the MMHC This limited their community contacts and isolated
them from the community Therefore personnel were encouraged to live
in the community as most workers do Furthermore they were encou g
to mv.te friends to v.s.t the hospital and to learn about treatment t
hand This open door policy attracted many commumty ^up ‘ ‘L rs a!s(>
pital Requests came from schools colleges c Mire ^ conducted

ciations and clubs of various kinds At firs

by staff members, but later patients took ^ the hospital staff

As another means of educating the p , ,Hncss and its

members participated in panel discussions development of a

treatment Another means of schools. colleges

volunteer auxiliary group including p P P cies an d even former
organizations such as the Junior League : sc i ^ vanou5 hospital de

hospital patients These volunteers w JL m$ ReIatlve s of hospitalized
partments to participate in treatmen p 8 h(e fee]ing5 an d to learn
patients were invited to group mee 1 g Finally, a study was made of
more about the hospital and its program ^ resu j t it was recommend

patient interactions with visiting re atl '® w vlS itors around the ward

ed that personnel should take time to s mt0 r visitor patient inter

Furthermore, personnel were encourage ^ arising Fundamenta

actions and to obviate difficulties t a * ^ ^ a cen tral role in the pa

ly, the position taken was that t c vi 1 , nor j^ept away

tient s treatment and must neither 6" re fiected in a number o i

The effects of the MMHC F ro !f ™ ”” d , 5charg e rate A revtctv of
ferent measures One fundamenta ^Os and 1930s newly a

hospital records indicate that clur ' n 8 hospital from about 10 to
psychottc patients tended to stay in community Tlie r

with about 35 percent being <J"d to ^ hosp „ a , .ration With
der were transferred to state h ° s P b( , d a b 0 ve, more inten»' e
the institution of the program e hospital increased to a

was offered, and the length of stay m then P

94 / restructuring the hospital community

aged to use creative imagination Since attendants represented the largest
single staff group they received special attention Weekly meetings were
held with ward attendants some of which were attended by the hospital
administrators Initially the meetings were didactic in nature, however,
they also provided an opportunity for attendants to discuss problems they
were having on the ward Eventually these discussions became the major
ward meeting activity Attendants learned a great deal and grew emotion
ally as a result of having the opportunity to discuss feelings about their
job

The second largest group of hospital ward personnel were student
nurses To help nursing affiliates develop a better understanding of their
own motivations and those of patients therapy groups were set up One
specific problem frequently discussed in these groups was the nursing af
filiate s tendency to play favorites among patients In the general hospital
where the nurse s role is highly structured she can relatively easily attend
equally to all patients In the mental hospital however the nurse is en
couraged to interact spontaneously with patients and, in so doing she
comes naturally to prefer some over others Such issues as why certain
patients are favored and why others seem to repel personnel were dis
cussed in these therapy groups In many instances it was found that su
perficial antipathies toward some patients could be strongly influenced by
t e group therapeutic process Another issue explored in the group thera
py sessions related to the optimal role of the psychiatric nurse Typically
* U ^ nt n i Urse j ls tau 8 ht to obey superiors unquestiomngly, to be seen
ther than heard and to carry out technical procedures quickly and
effiaent y In the restructured psych.atnc hospital spontaneity, freshness

eronn th T m ValUed m0re lhan n P d ^ed.ence The therapy
2 to ? hdped the nUrSmg student ch ange way she had been

be more simaM* 0 ” * g< ! neral hospital to an approach that was seen to
be more suitable in a psychiatric hospital

cal C , 0 ™da d tnnr 0rtS , Were , alS0 made to male the head ™rse on ‘he typ.
ro e the n ” ^ P 3 " ° f the lreat ™"t team In her trad.ttonal

Smce^Wbrn r , eSp ° nSlbk fOT ™rry.ng out the phystcans orders
viewed bv Lr ! q r y lnV0 'r d reS,nctlve measures P she came to be
eliminated P t he nura wa^TblVto 8 f th ° nty As restt >ctive practices were
and nlannmty , ri , 10 play a more S1 gmficant role in thinking

could heln tm M,V ‘T that br0Ught her closer ,0 patterns Thus she
immediate Z™'', Ward f "?’ ,sh,n S s organize crews lor beautrfytng the
aTweli a ; " ES bnd clothing for patients and so on Such roles
a and occuLT T ^ ' She “ uId take ln plannmg recreation

a bel mofe r * 1 °^™ the head nurse >„ confute herself

b v brouaht her k f ° r ™ d m ° ra,e tha " ^er before Tins tnev.ta

y rought her tnto closer contact with patients and with physicians who

SOCIO ENVIRONMENTAL TREATMENT / 97

kept to a minimum to reduce financial burdens on the patient and his
family, family problems are studied intensively by staff professionals
working with the patient, and efforts are being made to improve the pa-
tient's community relationships.

SOQO-ENVIRONMENTAL TREATMENT

Sanders’ program (Sanders, 1967; Sanders, Smith, and Weinman, 1967)
(established in a mental hospital that had long been regarded as a dump-
ing ground for the mentally ill) is an innovative hospital program based
on "sodo^nvironmental” treatment and also includes a study of the dif-
ferential effects of programs varying in degree of structure. The purpose
of all program elements is to encourage social interaction between pa-
tients. The term "structure” refers to the extent to which a given patient s
program forces him into interaction with fellow patients an ot lcrs. e
socio-environmental treatment program has three major componen^
social living situation, the interaction activity program, and various group
experiences.

The Social Living Situation

To establish a social living situation. “onm Game rooms

dormitory buildings into smaller ones havi g P ^

and living rooms L provided .and enchant
room and is responsible for its daily ^ ^ jn part> by thc patients

in a dining hall maintained and operat ,

themselves. . t _ : n5t jH the attitude that die

Formal meetings are held S hab ; IitaIed through social interne-

chronic patient is capable ot oei g patients assume responsi-

tion, and staff members are encourage furtIier st j mu late patient social
bility for their own social community. ant j a personal grooming

life, organizations such as a mode rai o ^ called the Alumni Club

club have been established. Another orga ^ hospital or for those

has been set up for patients preparing a jj patients is placement

who have already left. The treatmen j that they will live in the

outside of the hospital. All patients u nt j is> and that all program

therapeutic community no more 1 a ” outs ide the hospital. As adjust-
activities are preparing them or *'* demonstrates that he can care
mem to unit life progresses andd«P ^ njl grooming.an parujn-
for his own room, is able to look af,er “’LJ^ regu i ar work assignment, he
pate in assigned activities, and can ma privilege comes the rn P°"

is granted regular visits to the a * " and to become acquainted

sibility for learning hosv to travel on one

96 / restructuring the hospttal community

ot 80 to 90 days The discharge rate of newly committed psychotic pa
tients however, rose to between 80 to 85 percent during the 1950s In
addition it was noted that patients were better behaved m the hospital
than they had been in the past In fact, the mutinous, repetitive behavior
that characterized the catatonic schizophrenic and that is thought to be a
response to a threatening environment virtually disappeared
Another significant program effect was a change from the pessimistic
attitude of hospital personnel concerning patients’ futures to one of opti
mism and a willingness to trust patients to try their wings in the commun
ity The therapeutic forces in the patient’s home environment were con
sidered much more seriously than ever before Outpatient facilities were
increased, and contact was maintained with discharged patients Flexible
treatment plans involving a day or night hospital (see Chapter 4) were
at opte ork programs were developed within the hospital to prepare
patients to become wage earners when they were discharged

. ° £ au £ c ^ ie ^ng term effects of the MMHC treatment program, 100
was founTth" 1111 ? aftCr J Une 30, 1946 were followed for five years It
were til a tr f tment 70 W€r * discharged to the community, 29

hospital Sta 6 7 K °A er mental hospitals, and one died The average
?0 w ±7 75 , days At the “ d ‘he first year 72 o£ the original

moveT^:" 8 6 c ° mmun “ y and 20 were hospitalized Four tod
second year Tfi w V° “* a " d f ° Ur had d ‘ ad At the end of the
ble for the remai ** m the commun,t y» a figure that remained sta

7rLv er 7d2 n L ee r dy years ° Veral1 ’ « of ‘he ongtnal group

the enure group of 100 spenlTnavl dmm f five year P erlod Although
hospital during f ^ average of 18 percent of their tune in a

by a ' small group of To m °Ti° J ‘ h ’ 5 tIme WaS accumuIated

stous showing only brief perufd^ofTtnprovemen^^

Hems were studTd^t h^Ve^a^'ll COmnumity adjustment, 106 pa
views with the patient and lm r, m i '7 hos P 1,al commitment Inter
with the patient’s work 1 r ^ leir degree of satisfaction

Both the patients and their fa "T™* famdy Ilfe and community activity
al adjustment of the ex Dalien^' generaIly agreed that the occupation
‘.en,s J were wooing, Elghty per “"‘ ° f ‘ he p3

taming, or nearly so Despite satisfactlo^*’ 7 74 percent were sel£sus
some dissatisfaction was expressed concer*' lhe , patlent s being employed,
bly because debts incurred during hosp'tahz S . finanC,al S ‘ atUS - pr ° ba
tients financial situation Overall lamd' ^ 1 * pUt a stram on the pa
barely adequate, however andm 7 ad J ustmem was considered to be
almost unsatisfactory Such finrlm m ^ lumty ad justment was regarded as
forms of the hospZ L ^ *° shape the recent

ospital program For example, length of hospitalization is

SOCIO ENVIRONMENTAL TREATMENT / 99

degree of socnl interaction resulting in the greatest therapeutic benefit
three different types of structure were utilized and compared in a later
study of treatment outcome The various treatment conditions are depict
ed in Table 1

This table shows tint program content which forces on the patient dif
ferent kinds of socnl interaction increases from the minimally to maxi
mally structured treatment condition All groups have individual work as
signments cottage meetings and conferences with unit administrators In
addition the partially structured and the maximally structured groups
participate in the interaction programs with group therapy provided only
for the maximally structured group which also participates m patient

government

Only chronic patients with some potential for leaving the hospit wit
in 12 months were selected for the program while the severely regressed
or physically incapacitated were screened out The males in the program
ranged in age from 19 to 72 years (median age was 45) Eighty two per
cent of these patients were diagnosed as schizophrenic and had been hos
pitahzed from one to 36 years (median of 8 6 years) Severny one p
cent of this group had never married 61 percent had failed .to > comfdem
high school and most had worked at unskilled jobs such a dishwasher
laborer hospital orderly or factory worker Female patien P

Treatment

Condition

Maximally

structured

Partially

structured

Minimally

structured

Treatment Units Living

py Program Associated with Each Ireatmen
(from Sanders et al 1967)

Content of

Male Female Living Therapy Program

Units Units Situation

. F Therapeutic Group therapy^

A E /immunity Interaction program

Th puem individual work assignment

government unit adm, nutrition

-» —

Individual work a»igu»ml

0 ° Sr'mumty „ nlt ndn.in.itnl.on

<„> Regular ward Regular ward program*

' ' envi ronm ent - — — —

— — “
e work ass gmnent occu F

98 / restructuring the hospital community

with community resources Furthermore, he is encouraged to contact
community agencies that might help maintain him in the community after
discharge

The Interaction Activity Program

The interaction activity program involves small, relatively permanent
groups t at meet approximately one half of each day in relaxing mterper
sonal situations such as enjoying music and engaging in recreation, as
wc as in complex social situations m which sjiecific skills are taught

mong t lese skills are the fundamental techniques for meeting and inter
of !!LT , orina y Wltfl others . etiquette, and social dancing Many aspects
inv ( ,] SUC as SOC,a * eventS| cooperative living, and family style din
the artivov ** °PP ort ’i nities to practice the skills patients are learning in
intr outsirf JJ r °f ram rflc actlv, ty program also prepares patients for liv
ty Inst ucnl hos | lta throU S h dlscu «'<>ns, and trips into the common,
parma food c" 15 ° Be * d ? SUCh f ™damen,als as personal grooming, pre
ads of the newso™ 1 ' 1 ”^ ^ aCllltles and res °urces, and how to use the want

The mto" f aper , 0r the reSour « s employment agencies
a social therapist; ' ** “r ducted by a P^P ,eadcr calkd
In the hospital Social ,1 Cd by Staff meray>e rs from various services

pressures and support toamehSatT ' rame<1 “ ” Se Er ° Up P sycho,0 S lCa '
tients to adapt better to on,. imer P eTO >nal problems, to teach pa

mg the hospital another, and to prepare the patient for leav

Group Experiences

utilized to broaden 1'nd &™ U P therapy and patient government, art
therapy is seen to augment tf \eT'i ^ ' he resocIa hzation process ” Group
mem enriches the social hvme s, 111,00“°? pro S ram whde patient govern
late feelings discuss attitudes 5 and Jo" In Br ° ap thera py, patients venti
ences Adaptive behavior ,, » CCt on curren t interpersonal exfieri

behavior am d„ ° 15 enc °uraged and the reasons for malaHantlve

lrtlc ieeiin S s discuss attitudes and “ 8 raera Py« patients vem
ences Adaptive behavior is en CCt ° n current interpersonal exper
behavior are discussed Patient C ° Ura ^ ed aru * die reasons for maladaptiv
Ity for managing their own living ^ patients the responsibii

regular problem solving mppimn! , °® cers a nd a council are elected,
daily routine of the living unit ^ ^ held and throu g h this vehicle the
which election rules permit virti^u” 3 ^ Fre( l uent elections are held in
foies y a ' patients to serve in leadership

Research Design and Evaluation

Because Sanders an^hu^oHeam 3 ' 1 3Spec,s of the program as described
his colleagues were interested in determining the

SOCIO ENVIRONMENTAL TREATMENT / 101

condition tended to show greater awareness of other male patients than
did older patients in that condition

Since the program was aimed at reducing social isolation, degree of
verbal interaction was regarded as an important index Group leaders
were, therefore, asked after each session to rate patients with respect to
three aspects of verbal interaction the amount of talking done by a par
ticular patient in comparison with others during a session, how much of a
patient's conversation was directed toward the group leader and how
much toward other patients m the group, and the number of other pa
tients to whom the patient spoke during a given session For each aspect
of verbal interaction group leaders made a frequency rating on a our
point scale with a total verbal interaction score being obtained by adding
individual scores on the three items Statistical analyses of these scores
revealed that degree of program structure and level of reactivity are no
related to verbal interaction during treatment However, o er ma e pa
tients in the maximally structured treatment condition improve m
verbal interaction than did older male patients in partia y s tJ

grams Also in the partially structured program t ie ^ oun ^ , . j d
showed more improvement m verbal interaction p

tients Among females, .movement m verbal mteracuon was no,

to degree of program structure or level of reactmty „ am forces

In addition to social behavior manifested when the^ F ^

such behavior, Sanders and his colleagues iv d and mea5U red at

displays of social behavior Such behavior ]vB Xypica n y , a num
the monthly socials planned by the I» 1 bm jn the inte rvals be

her of structured activities occurred a others, take re

tween these activities patients could conv , a j s patients' behavior

freshments, dance, and the like During t es ^ ^ certain assumptions
was systematically observed and weig te in ’ raCtlon W1 th the opposite

made by the experimenters For examp e, behavior than interac

sex was seen to represent a higher or er of interaction were regarded
tion with one’s own sex and persona ones ^hus a spontaneous

as more significant than relatively i^pe l,«red a number of specific be
social behavior scale was develope t j, e highest weight mclu c

haviors with various weights T °* e {Jie opposite sex eating wit i

dancing with the opposite sex, ta ,n & Wlt}l t j ie opposite sex Simiar

the opposite sex. and engaging m a 53 the same sex received a slight >
behaviors engaged in with a mem partlC ipating, received sti ow
lower weighting Eating alone, or P p atien ts in die maxi
weightings' On this scale it behavior the most Pa

structured condition increased sp actually declin m P°

tients m the partially structured structured condition

neous social behavior, while those
showed little improvement

100 / restructuring the hospital community

gram were similar to the males in most characteristics except that only 36
percent had never married and their median length of hospitalization was
seven years

Both long and short term criteria were used to evaluate ‘ socio-envi
ronmental treatment effects Short term effects, determined immediate
y i tfV 1 P atient * iad concluded the program, were assessed by global so

Cm i u ? V1 ° r ’ awareness others, verbal interaction, and spontaneous
social behavior r

^ e ^ avi0r re f ers to the degree to which a patient interacts
sit ti servJ *tions were made in the patient’s living situation, work
Beb v,;r S - 0CiaI actlvlties and m his contact with hospital staff
behavior lb! 0 ° * SCale anchored at five points by descriptions of
mnle aVL d ‘"~ ^ dlfferent levds ° f f"nct,on.ng P For ex
™.h rdatne ' e SCa ' e the descr ‘P tlon read “communicates freely

:Z X r ” Sr ° UPS “ faCC ‘° faCe Participation is ap

2™ °PP~>es to interact’ At the other end of the

drawn (Highly ' P 100 IarIc edly isolated Uncommunicative With

.n.erva,r bl f^h:3 P d" ate) Th * ™ S d ‘" ded 15 «l" aI

■vertical scale anticir scri phons were distributed unequally on the
Rattngs^;^'^, "^attve bias ,n the d.stnbut.on of rattngs
first two weeks of the treat ' ,ere made by clinical psychologists within the
mem 0 to 12 months 1 ? nt P r0 8 ram and at the completion of treat
structured tL ™ nt ™ '° Und that P a "ems in the two

those in the mmimalIv P struI-t mS u dlSplayed £r eater social behavior than
male patient the longer the iT' P . r0gram II was also found that for the
scores attamed in ^os/n-p-i! 11655 duratlon 'he higher (better) were the
there was no relationship }' ment 8 oba l social behavior For females
program structure, age, or leng'thof dl'ness' S ° Clal behaVlor and de S ree o£

between patients It was re-iT ^ rdate *° 'he degree of interaction
must become aware of earl." 1 at before two people interact they
the patients ability to identify Tn ' emUy Thus a simple measure of
constituted the awareness of otT °'* P atients from recent photographs
quircd to identify by first last o lm measure Patients were simply re
"ho were currently m the n,c name th e photos of other patients

Test (PNT) was used to measure 'i™ 1 " 16 " 1 units The Photo Naming
patients within his own treatment ° pallents ability to identify other
groups and to identify females in ti' 1 ’° ldentiry male patients in other
non of the PNT to all male tiauems'ar'r tPCr,men,al Sr° u ps Admtmstra
beginning of the treatment nro-uim , i r ° m to fo " r wecks after l,le
that all three treatment conditions ntnm a ®?’ n at Us c °mpletion revealed
patients, hut that patients in ii,„ P _. P ' Cd lncrc ‘' lsc<l awareness of other
passed the other ,wS group, -"-red condition sur

b 1 ‘*cs m tlie maximally structured

SOCIO ENVIRONMENTAL TREATMENT / 103

tudes toward these relatives. Of the 101 subjects in the community, 93
had at least one relative with whom a contact could be made. Of the 86
patients on whom family contact information could be obtained, only 48
percent had contact at least once per week. Twenty percent had no con-
tact during the entire year preceding the interview assessing this variable.
A significantly greater number of females than males made weekly con-
tact with family members (65 and 35%, respectively) .

Patient attitudes toward family members were rated as positive, nega-
tive, or indifferent; for 74 subjects, 69 percent were seen to have general-
ly positive attitudes. For the most part, patients with positive attitudes to-
ward relatives were living with their families. Seventy-three percent of the
30 females who were not living with families indicated positive attitudes,
but only 35% of the 17 males not living with their families felt positively

toward them.

Another index of the degree to which patients were socially anchored
in the community was the number of friendships they had developed in
their immediate surroundings. Any community members the patient
could name and with whom he had regular contacts were considered to
be "his friend," excluding those he associated with through some func-
tional relationship (e.g., fellow workers or landlord) . On the basis of pa-
tients' self-report, there was a striking inability to establish friendship .
Thirty percent of the group were unable to name a ^ smg e nen , P
cent could name only one, and only 45 percent cou name wo •

Another measure of social adjustment was the num ^ °'
groups with which the ex-patient was affiliate . ’ was Q , pj per .
tients attended very few group activities on a regu ar ■ .

cent of the sample attended a

Club established at the hospital. Those ictiv i t ; es for Conner mental
went to church socials, "Y" activities, a

patients conducted by a variety of protocols, ratings

On the basis of the sum total of P percent of the sam-

of general psychiatric adjustment u showing limi-

pie characterized as being essential^ jally Abnormal. Overall, it

tations, and 25 percent being J udg . Ijmited in the degree to

was felt that the ex-patients were e A i, h o..gh more

which they maintained responsiDin y £eed themselves, the ma-

than half of the sample were able to om we]farc or social security
jority were unemployed and were supp mar ginal livelihoods, and

benefits. Those who were employe ea ^ involvement with other
their leisure-time activities reflected mt xistent It was apparent

people. Group affiliations were P r f ctl "“ * i£ the ex-patients had had
from Sanders' survey of ex-patients s . themselves in the com-

to take complete responsibility for maintaining

102 / restructuring the hospital community

The long range effects of the treatment program were assessed two
years after the completion of each patient’s treatment A follow up was
done on 101 patients residing in the community Of this group, 31 had
been m the maximally structured program, 28 in the partially structured
program 19 m the minimally structured program, and 23 in the control
group Interviews conducted with these patients focused on five areas of
a justtnent living situation, work, leisure time, interpersonal relations,
and psychiatric condition

, F m ^ e tke P atl ? tS in dus st udy had long, continuous periods of hospi
7 V 0/1 I01 *’ ami ' y tles were fragmentary, and the majority (about

j 77. 'It’* lvm S apart from relatives making it possible to assess their
thfmi e lndepe " dence A measure was developed of the degree to which
tTZT ! a " y KS P° nSlb,e for his own housing and for ob
were found ^ < ? ann ® lls own food More than 50 percent of the patients
own needs P-u ° assumin S more than minimal responsibility for their
wuhrestct t„ h" r rC alS ° ra ‘ ed f ° r the ad «P>4 °f their judgment
cent of the simnt W ^ Spent the ‘ r mone >’- with the finding that 42 per
men,, and23 pJLZjggft ^fn, 1 ™ **

them had poo^premmbid hw™*' P ™ Wem for these patients Most of
lei els, poor work records! tor * es (lack of job skills, low educational
they had done little me ai J tfleir Ion ® ,los prtalizations during which
m the job marked ' M WOrk decreased them desirability

percent of the group was ‘ S T' 5ur P ri5,n g that approximately 61

Pital Approximately 30 percem’hdd m!" ^ m ° nths outslde o£ the h ° S ‘
working held jobs requirmo 7 £u 1 tlme Positions Those who were
the jobs they hid held before h^ 51 era ^ y ^ ess s hiU than was necessary for
m the hospital their iob skill* h menta ^y disturbed, because while

Since such a lar J nad decI,ned

time community adiusunem 3 ^ °* tblS sam P Ie was not employed full
and types of leisure time activit^ measured b y a catalog of the number
tients engaged m 5 9 leisure en & a g ed in On the average, the pa

other people The largely nom,?, but only 1 8 of these involved

of these patients suggests a rather k C laracter the leisure time pursuits
tent, high frequency actiuties surh atTen ’ lsolate d existence To some ex
radio reading taking walks or vic^ Watcb,n S television, listening to the
because these activities were free ,*T e ,° tIiers were probably engaged in
niricial resources 1 10 €x patient had only limited fi

tionships involved an cvaluation^f Vi"!' 5113 " 1117 of In terj>ersonal rela
phone, or visits) lollar< j ' ' le nu mber of contacts (byroad

and children) siblings) /pout,

patient, and (b) an assessment of atu

THE "lodce” procram / 105

and particularly the more structured forms of it did have salient effects.
Considering these patients’ degree of pathology and long years of hospi-
talization, it is encouraging that a relatively short period (from six
months to a year) of socio-environmental treatment had some impact on
their work and social adjustment. These findings are encouraging enough
to suggest that a reorientation of the hospital milieu to include elements
of socio-environmental treatment over long periods of time might well
produce far more effective changes in hospitalized patients than have tra-
ditional treatment programs.

THE “LODGE'’ PROGRAM

Fairweather (1964) describes another approach to the treatment of the
chronic mental patient that combines elements of the therapeutic com-
munity and some entirely innovative features. Along with many others
who have been interested in the more effective treatment o t e c ironic
mental patient, Fairweather believes that one major problem is that be-
havior adaptive to hospital life is not adaptive to community life. Fair-
weather’s own research demonstrates that discharge patien s w 0
been living successfully in the hospital are often promptly rehospitaliKd
and readjust quickly to the hospital. Despite their success in th hospual,
they had apparently not been well prepared to live Thus, «o *

maximally therapeutic, the hospital must train 1 e pa ■ hospital

relevant roles. In addition, however, Fairweather recogn s th Mho
life is sheltered and far less demanding than commumty hfe so
thing must be done to help bridge the gap ' , - notion ,hat the

Fairweather’s innovative program dev0 >'“ .““L „. ould b( . through
ideal way of reconciling hospital and com™ joda] reference groups that
the establishment within the hosptta o s ^ ^ hler> oul5 idc o(

could function as organized units within J\ K ould be returned

the hospital as well. Thus an ent,r ' lo P f„ n clion as a single social

to the community at one time to c w ithin the hospital, their

unit. Having successfully adopted = ‘ S “\ d be minimized. Therefore, the
role-change necessary for life outsid which community-relevant

hospital program must create a socia u must establish the unit

roles can be practiced, and a separate progrmn m

outside of the hospital and help maintain . fishing social sellings af-

The within-Iiospital program OTJ and to a „ist others in

fording patients tlic opportunity to s ° ' ob l OT .solving groups were
doing so. Therefore, small autonom P - rot . nU i patients experi-
formed. To evaluate this group ‘ di ,ional hospital program

enccd the same svard program as t lose i

104 / restructuring the hospital community

mumty the majority would have had to have been rehospitalized They
apparently managed to maintain themselves by remaining relatively in
conspicuous avoiding demanding situations and being satisfied to func
tion at a level well below their premorbid adjustment
All of the foregoing analyses were done on the entire group of dis
charged patients regardless of their hospital treatment program Separate
analyses compared patients who had experienced the various types of
treatment programs as well as the control condition Among these anal
yses only living situation failed to reflect the influence of previous treat
ment

Socio-environmental treatment proved to be a significant factor in vo-
cational adjustment Those experiencing the two more structured pro-
grams were found to have significantly better judgment with respect to
vocations perhaps because these programs provided educational content
that had a significant impact on this factor Further analyses indicate that
females showed better vocational judgment than males and that differ
ences were not attributable to age Employment rates for patients who
a experienced the four different treatment conditions were 48 percent
or those in the maximally structured situation 37 percent for those in
the partially structured situation 42 percent for those in the minimally
uctured situation and 23 percent for those in the control condition
JzZL ]U T ent ^ S ? reflected dlfferences related to the hospital
mednn on ltlon ^ ot °mizing the distribution of friendships at the
pauems * hat Slgnificaml >' ™e friendships were formed by

condition” Mea* 0 environmenta l treatment than by those in the control
n^? S r up affihat,0n reflected a program by age inter
ment ZZs Z Tl C ° mro1 0r nunmialir structured treat

youn K nauems P °° reSt attendance at group activities while the

showed significant! , 6 maximalI y and partially structured conditions
entiated between the Control 16 " 631106 Social participation ratings differ
treatment ernnnc , 1 gr° u P and the three socio-environmental

trols participating * ^ JUSt Sh ° rt ° f slatistical significance with con
enc«Ce"X fo L7 re ,, PO ° rly ‘ han °‘ her ^ ^ge and sex d.ller
patients surpassed you reS[WCt to the SOCIaI participation ratings older

pated more acn^t than L e :i e r tlemS a " d “ pa “ ia

cio-environm77rcatm7r° rCS lnd!ca,ed that patients m the three so-

than those in the ™ t P ro gratns were in better psychiatric condition
be more disabled 7 Ah ° youn S er €x patients were found to

bersoUhe o„ttol P J n Chiat " rally “T* ° lder ° n “ ‘ h <= younger mem

Although as a P ?°T 8 ^ m ° St “ ark<:d d 'sab.I.ty

mumty functioning TdfeT^em dear"* d ' Splayed reIatlvely P°° r com
& seem clear that socio-environmental therapy

percent of time

THE LODGE PROGRAM / 107

tus was assessed at six month intervals through a 40 month period The
authors were interested in how long the discharged patient could main
tain himself outside the community, his employment status, and patient
self-evaluations as well as evaluations by a friend, relative, or acquaint
ance Patient self-evaluations were intended to reflect satisfaction with
living conditions, leisure activity, and community life Respondents famil
lar with the patients’ life situation rated them for the number of friends
they had, the amount of communicating they did verbally, the presence
of symptom behavior, their drinking behavior, their activity level, their
leisure activity, and their degree of social responsibility

The results of this study indicated that the lodge group remained in the
community and was employed significantly longer than contro s (see ig
ures 2 and 3)

r— 1 Trans t on to lodge autonomy

&88J Lodge group . — 1 — i

on .Unc tn the

2 The comparison of ^ el a l, l°G9)

month* of follow up (from Fa. tv rath

106 / restructuring the hospital community

except that they met as a group for two separate one hour periods each
day In the first of these they engaged m ward housekeeping, and in the
second they participated in a group discussion in which decisions and rec
ommendations were made concerning each of them The patient new to a
problem solving group proceeded through four distinct stages with the
entire group responsible for each member’s progress

The new patient was oriented minimally by the staff and referred to
the patient group, which provided a fuller orientation In the first stage,
the patient was required to care for personal needs, to be punctual for as-
signments, and to participate m orienting other new members for which
he received $10 and a one day pass each week In the second stage, the
patient was required to take a job and handle it acceptably, and during
this period he was paid $15 per week plus an overnight pass every other
week During the third stage, the patient was required to perform stage
one and two requirements satisfactorily and to demonstrate that he could
manage his own money and passes He was allowed to draw as much as
$20 per week plus as many as three overnight weekend passes per month
In the final program stage, the patient was not limited in any way con
cerning his funds or freedom to leave the hospital, but he was required to
begin making plans for his discharge from the hospital

On four weekday meetings task groups met among themselves to work
on one another s problems and to evaluate each other’s progress The
staff was occasionally invited to these meetings but only to serve as re
source people to provide needed information A fifth meeting was held
with the staff each week at which the group made recommendations con
cerning how each member s problems were to be solved The staff ac
cepted or rejected these recommendations, using this mechanism to con
vey the idea that action oriented solutions were preferable to ones that
did not result in action

A follow up study compared patients who had experienced the task
groups to those who underwent traditional treatment and found that task
group patients left the hospital significantly sooner than those receiving
traditional treatment In a follow up six months after discharge, however,
it was found that approximately 50 percent of both groups had been
readmitted Significantly, a preponderance of those readmitted were
chronic cases This emphasizes the need for the second component in
airweather s program the out of hospital setting that maximizes com

mumtv aniiittmpnt °

Fairweatlier, Sanders, Cressler, and Maynard (1969) have reported
extensively on the extra hospital program for the discharged chronic
mental patient Patients were released in groups to live in ' lodges ’ and
were compared with matched controls who were released individually to
participate in traditional outpatient mental health programs Patient sta

THE "TOKEN ECONOMY" / 109

patient behavior has resulted in a program known as the “token econo-
my” (Ayllon and Azrin, 1968). Token economy programs owe less to
the tradition of moral treatment and the therapeutic community than
does the program previously described. Instead, these programs grow out
oE Skinner’s theories oE learning based on operant conditioning. The the-
oretical position involved in this paradigm is well described by Ullmann
and Krasner (1969) , who term the treatment procedure that follows
from operant conditioning, sociopsychological treatment.

From the operant conditioning viewpoint, all behavior, psychotic or
otherwise, is learned as the result of reinforcement patterns. A reinforce-
ment is defined operationally as any stimulus associated with the in-
creased emission of the behavior that precedes it. All behavior results
from learning, defined as the acquisition of a functional relationship
tween an environmental stimulus and some response on the part o t

organism. , , . , „ ,

Two learning paradigms are identified. The first is t e *

lovian conditioning situation in which a stimulus prece es e p
and actually elicits it. The pairing of an unconditioned stimnlu , ««* «*
food, with a neutral stimulus, such as a bell, is an examp
food alone elicits salivation, and the association of the food I and the M
eventually makes it possible for the bell alone to prodms : Ration. This
is known as respondent conditioning. In the ot ler rcsponse is re-
called operant conditioning, the sequence of stimu that j, as

versed. f„ operant conditioning, the S'^Xdng wiU^use the
certain environmental consequences w * stimuli seem to

operant behavior to be repeated. Responses to ^ by the reactions
be operant responses. In other words, t ey ar r „ res ponse one

that they receive from others. To make a soCia and be re j n f 0 rced for the
must be attentive to stimuli, respond to t e . m ’ considered to be behavior
responses one makes. Abnormal behavior is ^ p 0nse to cues that most
that is unexpected, probably because it isin an upsetting and

people are inattentive to. This gives a no ^ ^ geen by Ullmann

unpredictable quality. A schizophrenic, or ^ atte nding to a different

and Krasner to behave as he does ^ caUS . j tse if js regarded as an op-
set of cues than most other people. tte ” ,

crant behavior that is shaped by rein orce . d by the hospital in

Ullmann and Krasner emphasize tbat is regarded as schizo-

maintaining and even promoting e \ st ; tut ion that looks on men-

phrenic. The hospital is a large imperso £ QSters j n the patient be ia\

tal disorder as a physical disease. s s 'The patient is viewe as no
tor such as cleanliness, quiet, an p assl - t j on that absolves him rom
being responsible for his behavior, a p° ^ wi£h roatc hes, belts,

blame but that also regards him as n

Med an percent of time in full-t me employment

108 I restructuring the hospital community
100 r—

80

Lodge group

□ Control group

Months

Figure 3 Companion of lodge and control groups on employment tor 40 months ot
follow up (from Fairweather et al 1969)

No differences were found between the experimental and control
groups on self and respondents evaluations Both patient groups were
highly satisfied with community life, obviously preferring it to living in a
hospital Respondents evaluations indicated that both groups were able
to assume the responsibilities of living the community, all patients en
gaged in passive leisure activities such as reading or watching television,
and few had many trends or were very talkative The major advantage of
he lodge situation was that it enhanced the patients’ ability to remain in
the community and to work productively

THE “TOKEN ECONOMY”

THE “TOKEN ECONOMY” / 111

measurement more convenient. Floor mopping, for example, was a good
choice, since it could only be done when a mop was available.

The selection of reinforccrs for desired behavior proved to be a partic-
ularly difficult problem. The reinforcements used in previous studies were
unique to each individual whose behavior was being shaped. Typically,
experimenters observed the patient over a period of time to learn what
reinforced his behavior effectively. Such a procedure, however, would be
entirely too unwieldly on the average hospital ward. To surmount this
problem, Ayllon and Azrin observed the behavior of a group of patients
over a period of time to determine what behaviors occurred with a high
frequency. They reasoned that whatever a group of patients frequently
did could be used as a generalized reinforcer for all of them. Six classes
of behavior were identified as being potentially reinforcing, privacy, ee
dom to leave the ward, social interaction with staff, attendance at re 1
gious services, recreational opportunities, and the opportunity topw
chase items at the commissary. Because the immediate rein
desirable behavior is considered to be very important rom e ,,
view of operant conditioning, and since the rein oroers es ^ ^ &
only be delivered at specified times, Ayllon an zrin d t h e

conditioned reinforcer as a bridge between the des.red espon * "
primary reinforcement. This conditioned reinforce,
kens that could be spent later for whatever primary ^rcers we
sired. As a result, this program was labeled * ‘j^ward, Ayllon and Azrin

In a series of experiments on a single P procedures were

were able to demonstrate that: ^ than any reinforce-

more effective in determining patients J reinforcers became

ment intrinsic to the job itself; (2) w en P ‘ wQrk was done;
freely available with no work requiremen , ount G f token rein-

(3) job preference was more closely re ate ^.j. for t jie task. This
forcement associated with it than to P^ tien , ^ ow significant patient be-
study provides an impressive demonstration ^ re inforcement. It also
havior can be elicited through the systema 1 uilmann and Krasner.

helps validate the learning principles escrl . tke development of to-
The work of Ayllon and Azrin has tker settings. One example is

ken economies in other hospitals and and Krasner (1968) on

the token economy that was set up y trat i on hospital for chronic
an 86-bed open ward o£ a Veterans Admnmnauo^ o£ , token

psychiatric cases. These authors repor e nts Ranged dramatica y

economy, approximately 90 percent o jjable activities, interacting

with respect to self-care, attendance

' cihilitv. features of the token

with others, and sense of responsibility . ficant

Ayllon and Azrin feel that one of tire s.fe

no / restructuring the hospital community

shoelaces, and the freedom to move about the institution. Since very few

staff professionals are available for a great number of patients, the at-
tendant becomes very significant in the patient’s life. The hospital attend-
ant has the most direct contact with patients and must organize and con-
trol large numbers of individuals. Reinforcements are, therefore, given
when patients are quiet and conforming. Since the attendant can influ-
ence the patients’ position with respect to the doctor and other patients,
he is a very powerful source of reinforcement: he can provide desirable
jobs, more comfortable living arrangements, minor luxuries, privacy, and
prompt attention to special requests.

Because the attendant is a powerful reinforcer, the behavior he encour-
ages is very readily learned. Unfortunately, much of the patient behavior
that pleases the attendant is maladaptive in community life. The good pa-
tient helps with daily routine, and remains otherwise unobtrusive in a

dull, drab environment where he is denied comforts, privacy, and stimu-
lation. Self-assertion, which serves very well outside the hospital, is extin-
guished. Even efforts to have contact with a physician who might help
with one s problems are looked on as disruptive. Thus, withdrawn, pas-
sive compliance which, incidentally, is often considered a hallmark of
schizophrenia, is encouraged in the hospital. Ullmann and Krasner go so
ar as to suggest that the behavioral consistency attributed to the schizo-
p emc process is actually caused by the methods used to treat it instead
of by anything inherent in the "disease.”

A number of studies have been done to validate many of the assump-
ZZ ™ t0 thC reinf0rcement a PP^ach (Ayllon and Michael. 1959;
lQfin IfT,?' a " d GoIdiam °" d . I960; King, Armitage, and Tilton,
'“'”5 Ayllon ; 1963 > ■ these studies, isolated responses were either
studi e ^ ll nguished in short, relatively infrequent sessions. Such

can he shan^uMf ' 6 u - at ttle behavior of even very disturbed patients
provide a rr lrou ® judicious use of reinforcement, but they did not
Ion and Arr ' a PP licable "> a " entire ward. Therefore, Ayl-

^ »> “ ° ut «» develop a behavior modification pro-

Sred a nl f T m the average hos P ital setting. Such a program

fininJ re f determining what responses shoulS be modified, de-

ani sett ^ T? ‘ ' V ° U ' d be USed “> P r ™°‘e desired behavior,
and setting up a study to test program effectiveness

perimemrrt" ed f ° r moditoti °" were those deemed by the ex-
— fT ° r mefU * l ° the P atie nt.” Such choices are,

culd on r^n l i 1 their experimental program, Ayllon and Arrin fo-
drT It wafr P “i n Se T ng meals - eleaning floors, and sorting laun-
bk and he T a ?“ r£S P° nscs 'elected be objectively measura-
ble, and be performed only at certain times of the day so as to make

A COMMUNITY BASH) OPERANT LEARNING ENVIRONMENT / 113

formance. Partly on the basis of the data provided by the program and
bridging cards, weekly summaries are prepared for each resident, and
these are reviewed at a clinical conference concerned with decisions re-
garding program changes, discharge, referrels to other facilities, and the
like.

Two treatment programs are designed to remove undesirable behaviors
and to substitute acceptable responses, the intensive workshop and the in-
terpersonal relations laboratory. Shortly after entering the institution, an
individually planned treatment program is designed for the new resident
that is directed toward behaviors deemed to be impairing his functioning
most significantly. At the intensive workshop the emphasis is on the de-
velopment of work-related behaviors as a preparation for entering a gen-
eral work program. Behavior is observed continuously in the intensive
workshop and reinforcers are applied liberally. Chits and, in s01 ^ in
stances, primary reinforcers are awarded for positive behaviors. iree
times a day chits are collected and converted to grickles. Bonuses are
awarded whenever a resident increases his reinforcement earnings over a
previous daily high. The resident is promoted from the intensive wor -
shop to a general work program when his output is^ satis ac ory a
displays a favorable ratio of positive to negative behavior.

The interpersonal relations laboratory functions in much the >
as the intensive workshop except that it emphasizes eve o
sonal skills. Residents attend this

minute sessions. Interpersonal activities relat s^nle olaying are

behaviors such as group games, group an

reinforced in the laboratory. Group discussi , j . situations

opportunity to reinforce rational, coheren p ^ behaviors. One series of
are used to condition increasingly sop m s i behavior might begin

roles directed toward a gradual refinemen point of "asking

with "asking a clerk for information" and progress ton I

the boss for a raise.” established and stabilized in

Once symptom-displacing responses ] at ; onJ laboratory, they are

the intensive workshop and interperson . . j es t he facility's gener-

maintained on intermittent reinforcemen ms j n eac h 0 f these activi*
al work, instructional, and recreationa P r S' ^ and re i n forcements are
ties, observations are made at regu ar m be jj av j or appropriate to the
awarded whenever a resident is engaging : ^ earn ,' n gs are related to

context. For the most part, however, a of CO untersymptomatic bc-

his output on a job rather than to ns delayed,

havior and, as in the real world, rein or dem recc j V es an assignmen
In the institution’s work program e\ s pedal project) , an »*

(kitchen work, household maintenan i , ^ d on previous work cx-

paid on a prearranged scale. Assignm

112 / restructuring the hospttal community

economy is that it is an environment within which disculturation (the de
tenoration o£ behavior important for living outside of an institution) is
forestalled They point out that even if the behavior disorder that necessi
tated hospitalization is cleared up, patients are often unfit for discharge
because of disculturation a process that causes families to lose interest in
the patient They feel that the community psychiatry ’ movement repre
sents a partial recognition of this problem

A COMMUNITY BASED OPERANT LEARNING
ENVIRONMENT

Horizon House is a community based program for treating psychotic men
which combines some of the features of Fairweather's * lodge ’ program
with the token economy system of Ayllon and Azrin (Henderson
1971 Kelley and Henderson 1971, Samuels and Henderson, 1971) The
goal of this program is to enhance the psychotic's community adjustment
by eliminating symptomatic behavior, improving interpersonal skills and
providing literacy and occupational skills Since the program was con
ceived of as an alternative to state hospital treatment patients reside in a
house within the community rather than in a hospital and are called resi
c ents instead of patients A token economy system is utilized to promote
behavioral change and programs for bridging the movement of the pa
lent rom t e experimental facility to the community are developed

is token economy utilizes a reinforcer called a grickle which exists
as fond 15111 W ^ 1C ^ can be exchanged for primary reinforcers such

ation ^ P asses and other privileges, admission to recre

lors bv tnaV 1 C nCkleS 316 awarded for a variety of desirable behav
the facilitv m A r Cntry on tbe program card carried by each resident in
taininp a runn ea J’ n J n S s a ^d expenditures are entered daily, thus main
? lt$ 3re USed to P™vi d e immediate reinforce
symDtoms twill rC f 3 Specific treatm ent regimen is designed to eliminate
vertable to Drimarv ° & ? VCn 1 " dividual Chits are not immediately con

recorded as rr^7 ^ Utare mstead collected periodically and

recorded as a corresponding number of grickles

they are vuLri Ya^A* 0 ** be ^ ome capable of working m the community,
ucha Joo't^ ff 5 C3r f S GnckIes are the « awarded for behaviors
are^llL r "oi ^ Punctual and, where employers

tlrZ^l r^T u ndging Card 15 US€d reinforcing good in

ncrCistr": PS , Wlt C °' WOrkerS and factory work perform

ular pa ^ g ^JF* 3 ** have becn earned by a partic
activuie X ™ Pr T am 3 ^ dS,ng Cards are graphic records of the
the patient has engaged m and indicate the adequacy of his per

A COMMUNITY BASED OPERANT LEARNINC ENVIRONMENT / 115

interviews, or providing leads for potential employment When a patient
demonstrates that he can maintain appropriate vocational and social be
havior, he is discharged from the facility and becomes a member of the
Alumni Club, through which he maintains continuing contact with the
program until such time as he no longer feels the need for it

Program Evaluation

Samuels and Henderson (1971) have reported on a study of the ef
fects of the community based operant environment for psychotic patients
The sample study includes psychotic men ranging in age from 18 to 55
years who were originally seen at a state psychiatric facility Excluded
from the sample were patients who were suicidal, assaultive, homosexual,
addicted to alcohol or drugs, mentally defective, or suffering organic
brain disorder Such exclusions were made to minimize incidents o anti
social behavior, since the experimental facility was located in t c center
of a residential neighborhood Random assignment of patients were m
either to a state hospital, the psychiatric ward olamumcip e jospi ,
the experimental operant facility For a total of 40 su jec »> the

had been treated m the operant facility and i t remain ^

state or municipal hospital, follow ups were done mo j ,

subject's admission to a treatment facility Workers who oP e «ed W
low up data were uninvolved with the patients un "8 from [he ml

and only became acquainted with them after t leir is jn Table 2

dally assigned facility Preliminary outcome data ar

This table indicates that although the ^-^3“' other
hospitalization is higher for the operant gr p . f or t h e operant
groups, the average 8 total time of hosp.<ahzauo„ *£ re
groups A considerably smaller percentag P (50%) or mu

hospitalized (28%) as compared to 'lid slate and aly pa
nicipal (66%) patients Furthermore, P [al on t heir return

tients spent a considerably longer perio i „ nccJ m percentages of
than did rehospitalized operant patients « m the various facilities
time spent m the community by patients operant program were cm
were not large However, those treate in community whereas

ployed an average of 34 percent of t ieir * ^ on j y an average of 29

city and state facility dischargees were ,

percent and 14 percent of their time, res P^ . u j , jCCt 5 at the conclusion

An evaluation was done of the st atu * . reported m Table 3, in i
of the 18 month followup period The * ticnls fewer operant

cate that in comparison to state an ci ov , n to be in the comm uni

subjects are in hospitals, more of t icm
ty, and a higher percentage are working

116 / restructuring the hospital community
Data were also available for an additional 77 subjects who had not
been in the program long enough for an 18 month follow up Analyses
were done combining the follow up data for these 77 patients with that

Table 2 Initial Hospitalization Rehospitalization, Community Ten
ure and Employment During the Follow up Period (549
Days) for Subjects from the Original Sample (from Sam
uels and Henderson 1971)

Facility of Initial Assignment

Vanables

Operant

N = 21

State

N = 10

City,

N —9

Days

Percent

Days

Percent

Days

Percent

Initial hospitalization (including
transfers)

Mean days

% of follow up period

167

30

156

28

99

18

Total hospitalization

Mean days

% of follow up period

180

33

249

45

202

37

Time in. community

Mean days

% of follow up period

369

67

300

55

347

63

Employment

Mean days

% of tune in community

125

34

42

14

99

29

Rehospitalization

= 6

n

= 5

n

— 6

Mean days

% of follow up period

45

8

178

32

154

28

Table 3 Status of Subjects from Original Sample at Completion of
Follow up Period (from Samuels and Henderson 1971)

Facility of Initial Assignment

Vanables

Operant

2V — 21

State

N = 10

City

N — 9

Subjects in hospitals
Subjects in community
Status unknown

Subjects working

« %

3 14

17 81

1 5

11 52

n %

2 20

7 70

1 10

2 20

n

2

6

1

3

%

22

67

11

33

A COMMUNITY BASED OPERANT LEARNING ENVIRONMENT / 117

available for the 40 subjects previously reported For this group totaling
117, the range of involvement in the program was from 5 to 18 months
with the average at 14 months The findings with respect to this group are
reported m Table 4

The data in this table indicate that the city hospital patients had a
shorter initial hospitalization than did those from the operant or state fa
cihties Total hospitalization was greater for the state hospital group than
for either of the other two, with the city hospital group again showing the
shortest period The operant group showed to best advantage with respect
to the percentage of subjects who were able to work during the follow up
period and the percentage who were able to work for more than one
month When rehospitalization was necessary, operant subjects also dem
onstrated superiority by remaining in the hospital for shorter periods of
time than did the state and city patients

Table 4 Initial Hospitalization, Total Hospitalization, Rehospitah
zation, Community Tenure, and Employment for Subjects
of All Groups When Examined Two Years after the Incep-
tion of the Project (from Samuels and Henderson, 1971)

Facility of Initial Assignment

Combined Combined

Operant State City

Variables N = 58 N - 24 N ~ 35

Initial Hospitalization
(including transfers)

Mean days

130

142

95

Total Hospitalizauon

Mean days

168

180

143

Time in Community

Mean days

274

235

288

Employment

Mean days

174

136

196

No of Ss who worked dur
mg follow up period

32

55%

7

29%

16

46%

N of Ss who worked over
one month

27

47%

6

25%

13

37%

n —

20

n

— 6

n

= 13

Mean days

Percentage of Ss rehos
pitalized during 2 year
penod

92

34%

151

25%

142

37%

118 / restructuring the hospital community
This operant program for seriously disturbed patients conducted in a
facility located in the community, is a very interesting and hopeful depar-
ture in the treatment of serious mental disorder. Like many other pro-
grams that are deeply concerned with the debilitating efEects of long peri-
ods of institutionalization, its aim is to keep patients in close touch with
the community and to bolster the patient s interpersonal skills, particular-
ly those that will help him to adapt to community life. The primary tool
in this effort is the operant technology that has proved to be successful in
shaping behavior within institutions. The extension of this technology to
settings within the community and even to actual work settings is a most
interesting and potentially fruitful departure.

THE MENTAL HOSPITAL AS A RESORT

A fundamental assumption in many of the hospital programs described,
as well as in the writings of contemporary observers of the hospital scene
such as G oilman (1961) , is that the patient is a victim of a set of forces
that he is powerless to oppose. Recently, Braginsky, Braginsky, and Ring
(1969) have reported a series of studies done in a mental institution that
leads them to conclude that the patient is far from an entirely passive vic-
tim of hospital forces. These authors believe that patients exercise a
counter power that gives them considerable control over their own fate.
Because the schizophrenic is looked on as differing from the rest of hu-
manity, as suffering a disintegrative' disease impairing virtually all psych-
ic functioning, and as being an involuntary victim of an uncontrollable
illness, Braginsky et al. feel that it is difficult to recognize that patients
are capable of a rational life-style in the hospital which provides many
personal satisfactions.

Some studies were directed at the patients’ tendency for "impression-
management,” a term referring to one's capacity for managing expressive
behavior in such a way as to control the impressions that others form of
him. One simple study demonstrated that patients who thought they were
responding anonymously to a questionnaire concerning hospital condi-
tions gave significantly fewer ingratiating responses than patients who
knew that their responses could be identified. In a more elaborate study
two groups of patients, a recently admitted group and a group hospital-
ized, at least, three months (most of this group had been hospitalized for
more than three years) , were asked to respond to the same instrument.
For half of each group the test was called a "mental illness test” and for
the other half it was labeled a "self-insight test.” Those experiencing the
mental illness condition were told that high scores would heighten a per-
son's chances for remaining in the hospital for long periods of time.

THE MENTAL HOSPITAL AS A RESORT / 119

Those who toot it as a self-insight test were told that high scores would
reflect inner mental health and would lessen the likelihood of a long peri-
od of hospitalization. It was h>pothesized that patients who had already
been in the hospital for a long time had some wish to remain whereas
newcomers would be looking forward more eagerly to discharge. As hy-
pothesized, significant differences were found between old-timers and
newcomers depending on whether the test was taken as a mental illness
test or a self-insight test. Old-timers scored significantly higher on the
"mental illness’' test and significantly lower on the "self-insight” test than
did newcomers.

To test the effectiveness of patient impression-management as a count-
er-power tactic, three groups of patients were asked to respond for two-
minute periods to the question: How are you feeling? One group was ad-
vised that the interviewer was interested in assessing readiness for dis-
charge; a second group was told that the interviewer was interested in de-
termining whether the patient should be living on an open or closed
ward; the third group was told simply, “I think the person you are going
to see is interested in how you are feeling and getting along in the hospi-
tal.” Psychiatrists were asked to rate tape recordings of each of the two-
minute segments for the degree of psychopathology and the amount of
hospital control needed by the patients. Since all patients had long peri-
ods of hospitalization, it was hypothesized that they would be motivated
to remain in the hospital, but that they would want to retain open ward
privileges. Results indicate that patients in the open ward condition were
regarded as the least mentally disturbed and requiring the least control,
patients in the discharge condition were rated as suffering the greatest
degree of psychopathology and needing the greatest amount of control.
Ratings of patients in the third group, who were asked merely to reflect
how they were feeling and getting along, fell between the other two
groups.

In another series of studies, Braginsky et al. identified three specific
adaptive styles among hospital patients: spending much time on the
ward; spending a great deal of time at some work assignment; and be-
coming a " mobile socializer.” These styles were associated with age , atti-
tudes about hospitalization and patienthood, goals, and interests. Al-
though psychopathology was not related to these adaptive modes, each
style led to different hospital outcomes with respect to how much and
what type of information was acquired about the hospital, the length of
hospitalization, discharge rate, and involvement in therepeutic programs.

The authors concluded from these studies that patients can successfully
use their environment to their own satisfaction by maintaining personally
valued life-styles even when such styles depart from institutional values.

A further study was directed toward the "invisible” patient, a type

120 / restructuring the hospital community

about whom little is known by hospital staff. It was assumed that the pa-
tient who is not well-known to staff actively seeks anonymity. Results in-
dicated that patients vary considerably with respect to visibility within the
hospital, and that this variability is a function of patient-initiated ap-
proach or avoidance of the psychiatrist. Visibility was also found to be
unrelated to psychiatrist’s ratings of psychopathology. It was related to
discharge, however, with the more visible patient being more likely than
the invisible ones to be discharged.

On the basis of these studies, Braginsky et al. likened time spent in the
hospital to time ordinarily spent on weekends or vacations and drew an
analogy between the mental hospital and the vacation resort. In the com-
munity, leisure time is the exception whereas within the mental hospital it
tends to be the rule. Thus a study was done to demonstrate that the newly
admitted mental patient’s way of life is more similar to weekend life out-
side of the hospital than it is to the weekday routine. The conclusion
drawn was that the hospital is used as a “resort” to satisfy patients' he-
donic needs. Furthermore, the authors demonstrated that newly admit-
ted patients having friends who were ex-patients entered the hospital with
attitudes more similar to long-term patients than first-admission patients
without such friends. That being the case, some newly admitted patients
were suspected of entering with the intention of satisfying hedonic needs.
In line with this hypothesis, it was demonstrated that several patients ad-
mitted from a given town were much more likely to be living in close
proximity before entering the hospital than would be expected by chance.
The authors presume thereby that many prospective patients learn be-
forehand about the institution and may even enter to be with old ac-
quaintances.

Such data suggest that the mental hospital is seen as a resort. It- is not
necessarily one where patients "are holding hands and frolicking merrily
across the hospital grounds.” However, it is like a resort in that the hospi-
tal imposes minimal external demands, offers residents attractive physical
settings with many social activities, does not expect residents to be pro-
ductive, and maximizes the opportunity for them to choose a personal
life-style. Both institutions, the mental hospital and the resort, attempt to
replenish residents so they will be better able to meet life’s demand.

These studies have led Braginsky, Braginsky, and Ring to suggest a
model hospital program. They believe that since patients actually use the
mental hospital as either a temporary or permanent refuge, society should
face up directly to this fact and provide opportunities, through means
other than mental hospitals, for withdrawal and renewal. In essence they
propose that each community set up a small institution offering its mem-
bers an opportunity to get away from it all without being degraded as

CONCLUSION / 121

menial patients. Such retreat facilities are already available for the
wealthy so that what is primarily needed are similar institutions for the
less affluent. Braginsky et al. expect that if retreats of this kind existed
many oE the traditional “symptoms" of mental illness would disappear al-
together. Since people would understand that there was no need to ap-
pear mentally ill in order to remain in the institution, they would no long-
er act “sick." Those feeling the need to withdraw permanently might find
employment in these retreats as staff members. Central to this plan is the
idea that these retreats are not hospitals to deal with illness, but places of
refuge for those who need a break from daily routine. Giving everyone
the opportunity to get away at times should, furthermore, make life more
bearable for all members of society. Visits to these retreats would serve
as a shot of “social adrenaline," enabling people to become more fruitful
and productive citizens.

CONCLUSION

The revolutionary changes brought about in hospital care during the late
18th and early 19th centuries were in response to a recognition of the im-
portance of the environment on the mental state of the hospitalized pa-
tient. This was followed in the United States by a period characterized by
“moral treatment" in many mental hospitals, an approach that placed
great stress on the therapeutic community forces within the hospital. Par-
adoxically, during the latter half of the 19th century a renewed emphasis
was placed on the theory that serious mental disturbance was entirely
constitutional, and as a result a drastic change in hospital practice oc-
curred. Since constitutional factors were thought to be paramount in the
etiofogy of mental disorder, there was fittfe need for concern about the
patient's hospital environment. Institutions could be managed more eco-
nomically if they were larger and were manned by a staff concerned pri-
marily with the patient’s survival needs.

Many of the recently developed hospital programs appear simply to be
revivals of the old moral treatment approach. Stress is laid on patients'
doing useful work, assuming responsibility for managing their lives, and
having the recreational opportunities and freedoms that characterize life
outside of an institution. In addition, some of these programs are begin-
ning to take a very detailed look at the hospital as a social setting and
how it fails to prepare the patient for successful life outside. Many of
these programs are being carried out within theoretical frameworks un-
dergoing empirical test. Treatment approaches are being carefully evalu-
ated, and studies are being done to better understand the impact that the

122 / restructuring the hospital community

hospital environment has on the patient. These very positive steps
may lead to important structural and functional changes in the mental
hospital.

In some measure the greater “openness” characterizing innovative hos-
pital programs in which physical restraints are minimized and patients
have increased freedom may have become possible because of the wide-
spread use of tranquilizers. While the typical patient may have always
been capable of more self-restraint than he was usually given credit for,
the fact that tranquilizers were in use undoubtedly encouraged some hos-
pital personnel to attempt a more open hospital atmosphere. As the expe-
rience of Rosenhan (1973) would suggest, however, in many hospitals
the use of tranquilizers has, no doubt, made it possible for hospital per-
sonnel intent on doing a purely custodial job to have only minimal con-
tact with patients, a practice that leads not to greater openness but, if
anything, to psychological stagnation. On a hospital ward where patients
might lose control at any moment, an aide would simply not be able to
spend only an average of 11 percent of his time among his charges, as
Rosenhan found. The aide would inevitably be with patients most of the
time he was on duty, would interact with them considerably, and would
come to know them very well as people. Hence, the advent of the tran-
quilizer is a mixed blessing.

The various approaches to the open hospital we describe have in com-
mon an intense involvement of all personnel with the patients. Open hos-
pital programs demand considerable sensitivity to patient experience and
a constant questioning of environmental impact on behavior. As such, it
is most demanding of those individuals having the most direct contact
with patients. This calls for a considerable upgrading of the skills of tra-
ditional aides and nurses, and even for the development of new types of
personnel. Associated with this shift is an alteration of the status hierar-
chy of the hospital. Where formerly the physician, who had minimal con-
tact with patients, was considered the institution’s primary therapeutic
agent and the ultimate authority in patient disposition, in the open hospi-
tal many of his prerogatives must be shifted to personnel who live more
closely to the patient. In effect, this reduces the physician’s status from
the all-powerful authority to that of a technician.

The development of new cadres of therapeutic agents, training them,
supervising them, and making a career possible for them in an organiza-
tional structure having rigid traditions are some of the important issues
facing community psychology. Reshuffling the power structure of a long-
established institution that has received shockingly little public support is
an additional problem of no mean proportion. Its major ally in the task it
faces is the blatant failure of traditional practices and the persistence of
an aroused public conscience.

references / 123

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psychiatric ward Journal of Abnormal Psychology, 1968, 73, 37-43
Ayllon, T Intensive treatment of psychotic behavior by stimulus satiation and
food reinforcement Behavior Research and Therapy, 196$, 1 , 53-61
Ayllon, T , 8. Aznn, N H The measurement and reinforcement of behavior of
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Ayllon, T , & Azrjn, N H The token economy motivational systems for therapy
and rehabilitation New York Appleton Century Crofts, 1968
Ayllon, T , & Michael J The psychiatric nurse as a behavioral engineer Journal
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Fairweather, G W , Sanders, D H , Cressler, D , 8. Maynard, H Community life
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Sanders, R New manpower for mental hospital service In E L Cowen, E A
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Englewood Cliffs, N J Prentice Hall, 1969

5 - programs for infants
and preschool children

The previous chapter described treatment or teritiary prevention pro-
grams. Although innovative in a variety of ways, these programs continue
to reflect the traditional mental health orientation toward the ameliora-
tion of identified psychological disturbances. This chapter is principally
concerned with interventions designed to reduce the incidence of psycho-
logical dysfunction. The programs discussed fall under the primary pre-
vention model in that they concentrate on, “identifying current harmful
influences, the forces which support individuals in resisting them, and
those environmental forces which influence the resistance of the popula-
tion to future pathogenic experience*’ (Caplan, 1964) . Afore specifically,
the present chapter focuses on programs for infants and preschool chil-
dren whose environments are thought to provide inadequate resources for
facilitating growth and development. Stated in positive terms, the inter-
ventions to be discussed seek to provide high-risk diildren with the op-
portunity to develop necessary skills for living.

125

126 / programs for infants and preschool children
The choice of the infancy or preschool period as the temporal point for
intervention reflects several assumptions The young child is a rapidly
changing organism who may be particularly susceptible to positive influ
ences his acquisition of life skills at tins time forms the foundation for
future adaptation and he has not yet learned many of the maladaptive
behaviors that would have to be unlearned first if intervention vs ere to oc
cur later in his life (Bloom 1964) Moreover, many theories of human
development hypothesize that there may be critical periods for the ac
quisition of certain types of responses and that it may be difficult or even
impossible to fully compensate a person for the absence of facilitative ex
penences that should have been available but were not

Although the potential advantages of very early intervention arc evi
dent implementation of primary preventive programs involves serious
conceptual and practical difficulties A major problem arises from the
fact that the specific environmental antecedents of most psychological
disorders are not known No one can yet say with certainty what if any,
early life experiences contribute to the later appearance of a complex be
havior dysfunction such as schizophrenia As a result many workers in
early prevention have set conservative goals for their programs often
centering around the enhancement of cognitive development (Tizard
1970) The narrowness of professed goals does not rule out the possibili
ty however that these programs will ultimately be shown to have sub
stantial impact on the general well being of the individual Hunt (1961)
has argued for example that the unfavorable environmental conditions
that impede cognitive growth may also create generally unmotivated and
emotionally deficient people A practical difficulty associated with early
intervention is the problem of reaching the target population High risk
infants and preschoolers cannot be identified through the public educa
tional system as a rule Furthermore it is not always easy to convince
parents caretakers or funding agencies that intervention is desirable with
children who have not yet manifested signs of disturbance

The first programs we discuss involve children who are institutionalized
and who are therefore relatively easily reached Not only is it compara
lively convenient to set up programs of service for children gathered in
institutions but it is also possible in some instances to control and to
observe environmental effects fairly thoroughly as a means of refining in
tervention techniques

PROGRAMS FOR INSTITUTIONALIZED CHILDREN

Substantial evidence has been accumulated over the years indicating that
children raised in orphanages and similar institutions often suffer severe

PROGRAMS FOR INSTITUTIONALIZED CHILDREN / 127

emotional and intellectual damage (Dennis and Dennis, 1941, Spitz
1945, Prmence and Ltpton, 1962) In 19S9, Skeels and Dye mounted a
program in an institution that was well ahead of its time and that, in ret
rospect, may be seen as providing an early model for primary prevention
programs using nonprofessional helping agents

Skeels and Dye did not plan their intervention on the basis of a full un
demanding of the possible effects of institutionalization, nor on the basis
of a well founded preventive strategy Their efforts were the results of an
accidental observation Two infants in an orphanage, aged 13 and 16
months, had been adjudged to be feebleminded and were moved to an m
stitution for retardates where they were cared for largely by teenage fe
male inmates A psychologist observing the two children on the ward about
six months later noted striking changes m their apparent developmental
level The children were retested using a childrens intelligence test and
were found to have gamed 31 and 52 IQ points since their transfer In
trigued by this observation, Skeels and Dye arranged to have 13 other
‘ feebleminded” children placed in the care of the brighter retarded girls
in the institution

The 13 transferred children ranged from about 7 to 36 months of age
and had an average IQ of 64 3 A control group of children with a higher
mean IQ was selected from among children who remained m the regular
orphanage program The experimental children remained m the special
setting for periods ranging from 5 7 to 52 1 months As is indicated in
Table 1, these children all showed substantial gams in IQ While the ex
perimental group gained an average of 27 IQ points the control children
actually lost an average of 26 points over similar time spans Skeels and
Dye concluded that the enriched stimulation and one to-one relationships
provided by the retarded women were the operative factors m the dra
matic intellectual gams made by the experimental group children

Obviously the longterm effects of any program directed at very
young children cannot be evaluated for many years The research mitiat
ed by Skeels and Dye provides one of the few examples of a program be
gun far enough in the past to provide us with data on the adult status of
the children served Skeels (1965) was able to locate all of the children
who had originally been studied The only subject lost from the sample
was a child in the control group who had died Skeels found that none of
the children m the experimental group were receiving institutional care
while four of the controls were in institutions for the retarded or mentally
ill Furthermore, II of the experimental subjects were mamed and 9
had children Only 2 of the original controls were mamed at the time of
the follow up study These findings while not conclusive, suggest that the
intervention may have enhanced not onl> cognitive development, but
general socnl adequacy as well

Arranged according to age at time of transfer from youngest to oldest
Stanford Binct IQ

PROGRAMS FOR INSTITUTIONALIZED CHILDREN / 129

The Skeels and Dye findings were not well received at the time of their
original publication. Indeed, some experts derided their evidence because
it challenged the then popular theoretical bias that IQ was hereditarily
predetermined and could not be altered. Not all the criticism of the
Skeels and Dye research was based on theoretical objections, however.
There were undoubtedly methodological problems with the study, includ-
ing the fact that the experimental and control children were not com-
pletely comparable prior to the intervention. The higher initial IQ of the
control group may have meant that the control children had more room
to drop in IQ whereas the experimental group had more room to im-
prove. In any event, the research did not permit the identification of the
precise environmental factors that could have accounted for the observed
effects of the intervention.

Rheingold (1956) reported a somewhat different effort to modify the
environment of institutionalized infants. Unlike Skeels and Dye, the au-
thor herself became the new element in the child’s milieu, and it was thus
possible for her to specify fairly precisely what experiences had been add-
ed. An even more important distinction between Rheingold's study and
the earlier research is to be found in the description of program goals.
Rheingold was relatively disinterested in raising the IQ scores of the chil-
dren. Her goal was to increase their responsiveness to social stimuli.
Relying on accumulated evidence (such as the findings of Dennis and
Dennis, 1941, and Spitz, 1945) that institutionalized babies show inade-
quate emotional and interpersonal behavior, Rheingold offered herself as
a surrogate mother figure who would partially replace the multiple insti-
tutional caretakers and, thereby, increase the child's opportunity to devel-
op appropriate interpersonal attachments.

The children Rheingold studied were 16 infants residing in an orphan-
age hospital. The infants were six months old at the outset and were se-
lected to exclude children with known physical or mental defects of any
significance. In choosing children with no identified deficiencies, Rhein-
gold was employing a true primary preventive strategy (in contrast to
Skeels and Dye whose work might be regarded as having secondary pre-
ventive goals) . Eight of the infants were designated as controls, and were
matched with eight experimental infants for age, IQ, and pre-intervention
social responsiveness.

In the experimental condition, Rheingold was the sole caretaker of
each infant for a total of 300 hours distributed over eight weeks. She
tended to the child’s physical needs, talked to the child, and otherwise
provided social stimulation. The control infants were cared for by the
usual retinue of institutional workers. Both control and experimental chil-
dren were, however, tested weekly during the eight weeks and for four
weeks thereafter. The tester was a person unfamiliar to both groups of

ISO ( programs for tnfants and preschool children

children (at least, initially) , and the responses were recorded by an ob
server who was kept uninformed about the experimental design
The chief measuring instrument was a response checklist for recording
the child s behavior when he was approached by an adult The examiner
was instructed to engage in a two part series of standardized behaviors
intended to elicit social response from the infant (see Figure 1) In adch
tion to being observed with the designated tester, the child was also
scored Cor his performance with Rhemgold and with a complete stranger
Thus by varying the degree of familiarity of the adult in the test interac
tion, Rhemgold was able to determine whether any changes in social re
sponsiveness were generalized as opposed to being simply a function of
increased familiarity with the particular adult figure
The results of the study supported the general hypothesis that a brief
period of increased interaction with a single caretaker could increase the

The four situations in Part A were as follows

1 The adult stood approximately three feet from the child's crib, smiled at
the child, but did not speak

2 The adult went to the crib, leaned over the child, smiled, and said warmly,
"Hello, baby, how dre you’" which could be repeated a second time

3 The adult tried by any means to get the child to smile, and as soon as the
child smiled, frowned and scolded him m an angry tone of voice, saying,
"You naughty baby, what did you do?" These words too could be re-
peated but only once

4 After the lapse of at least 15 minutes (in order that the baby might forget
the scolding), the adult, concealed by a sheet thrown over the side of the
crib, called to the child, saying, "Hello, baby" or "Come on, baby"

The three situations in Part B were as follows

1 The adult stood at the side of the crib, smiled, and talked to the child as
In Part A, 2

2 The adult picked the child up, walked to the center of the room, held him
In her arms so that the top of his head was level with her shoulder,
smiled, and talked to him as in Part A, 2

3 The adult returned the baby to his crib, placed him on his back, and
stood at his crib, silent, and not looking at him

Figure 1 Experimental situations used to assess infants social Responsiveness
(Rhemgold, 195CT

PROCRAMS FOR INSTITUTIONALIZED CHILDREN / 131

social responsiveness of institutionalized infants The experimental group
of infants showed general!) greater interest and more positive behavior
toward the examiners than did the control group The experimental in
fants were particularly responsive to Rhemgold herself, indicating that
some specific attachment had developed in addition to the general in
crease in social interest It had also been hypothesized, however, that
children in the experimental group, as they became more attached to
Rheingold, would become more fearful of strangers and this prediction
was not confirmed The two groups of children continued to differ in social
responsiveness throughout the four week period following the discontinua
tion of Rheingold’s visits with the experimental children No sigmfi
cant differences between the groups were found on measures of intellec
tual or motor performance

In 1959, Rheingold and Bayley (1959) presented the results of a fol
low up study in which 14 of the original 16 infants were revisited about a
year after the last previous contact Virtually no residual effects of the m
tervention could be found None of the experimental children gave evi
dence of recognizing Rheingold or of special responsiveness to her No
differences were found to distinguish the control and experimental chil
dren, except that the experimental children seemed to engage in more
spontaneous vocalization Optimistically, Rheingold and Bayley sought to
explain the apparent absence of lasting effects by noting that all of the
children seemed to be doing well and that most had been adopted, thus
gaining the chance to develop socially to a degree that would naturally
obscure the effects of the brief intervention Even so, this follow up study
may be viewed as providing one of the earlier indications that the effects
of intervention in infancy might be dramatic but short lived The follow
up done by Skeels (1965) does, however, suggest that under certain con
ditions an early intervention may have a longrange impact

The two efforts described in this section provide several illustrations of
the distinction between a preventive intervention and a ‘ treatment mod
eled on the approach of the physician One important difference is found
in the fact that both projects neglected the first step in general medical
practice, that of waiting for the referral of the service recipient Despite
the impossibility of self referral by an infant it would still have been pos
sible for Skeels and Dye or Rheingold to have waited for the institutional
caretakers to present their wards as cases needing treatment In fact,
however, Rheingold selected children adjudged to be free of defect, while
Skeels and Dye chose children seen as having a defect that was thought
to be irremediable Thus both projects directed aid at individuals not al
ready judged to require treatment Furthermore, the two programs omit
ted the next step prescribed by the treatment model, the establishment of
a firm diagnosis carrying implications for the appropriate ameliorate e or

132 / programs for infants and preschool children

curative procedure. Steels and Dye and Rheingold, rather, began with
the hope or assumption that no defect existed in the children that might
not be related to the inadequacies of the institutional environment, and
that it would be senseless to seek to identify the hidden flaw in the chil-
dren when it might be possible instead to alter their surroundings. A third
deviation from the medical approach is found in the nature of the inter-
ventions themselves. Neither program involved the selection of a "specif-
ic," that is, a remedy specially suited to the cure of a particular disorder,
to be administered by a highly trained professional. Rheingold was con-
tent to offer her experimental infants an experience that any competant
mother might have provided, while Skeels and Dye placed their children
in the hands of women who could hardly have been able to understand,
much less carry through a sophisticated treatment procedure. To a great-
er or lesser degree, the preventive programs to be discussed in the re-
mainder of this chapter and in others that follow will similarly illustrate
deviations from the treatment model of general medicine. Concepts of re-
ferral, diagnosis, and discovery of a specific may simply be inappropriate
where the source of psychosocial inadequacy is perceived as lying in the
nature of the community, and where the helping approach is aimed at
preventing these forces from impacting on individuals to his or her subse-
quent detriment.

INTERVENTIONS CENTERED IN SPECIAL SETTINGS

Most preschool children are not, of course, institutionalized. The majori-
ty of children whose environments provide inadequate early experience
are probably the children of the poor. Reaching these children is far
more of a challenge than reaching the children who are already gathered
in public institutions. The mental health worker must often choose be-
tween the relative efficiency of creating special children's centers and the
possibly greater benefit of entering the home setting itself. In this section
we focus on programs involving the establishment of special preschool
environments.

At first glance, the strong movement to provide special settings for
very young children would appear to be one of the most successful as-
pects of the prevention movement. However, much of the impetus for
early intervention comes from an altogether different source. Changing
economic conditions and new conceptions of sex roles have led many
women to seek reentry to the job market while their children are still
young. This has led to strong public pressure for the government to sup-
port day-care facilities and other forms of child care that enable women
to work. As day-care facilities have proliferated, the community psychol-

INTERVENTIONS CENTERED IN SPECIAL SETTINGS / 13 $

ogist has conveniently gained access to a population that might otherwise
have been difficult to reach. This phenomenon of the mental health work-
er capitalizing on the opportunities provided by general social changes is
exemplified in many other programs described in this book. Even where
the community psychologist cannot himself initiate wide-scale programs
of service, he may be able to introduce a psychological perspective into
projects initiated primarily to fill other needs.

Currently, the most massive program of preschool intervention is Pro-
ject Head Start, initiated in 1964 by an act of Congress. As with the
day-care movement the perceived need for this project was only partially
related to mental health considerations. Project Head Start was founded
as a part of the war on poverty in an effort to break the cycle that leads
to generation after generation of people who can find no useful economic
role in our technological society. This mandate was hastily translated into
a network of preschool centers administered with a considerable degree
of local autonomy (White, 1970) .

Despite the ultimately economic objectives of Head Start, the immedi-
ate goals of the program included several types of psychological impact.
The effects that were sought included aiding the emotional and social de-
velopment of the child, increasing his sense of self-worth, and improving
family-child interactions by influencing both. Thus the project demanded
an interdisciplinary effort to aid children in matters of health and educa-
tional readiness, but placed considerable emphasis on psychological de-
velopment.

By 1970 more than three million children had participated in the Head
Start program. It is no simple matter to describe what this participation
has entailed, however, since the program has been made up of literally
thousands of separate and unique efforts. Some programs have offered
only summer experiences, others have provided year-round half-day en-
richment, and still others have offered full (school) day sessions year-
round. Furthermore, the specific goals of the individual centers have dif-
fered. A major study of Head Start's impact was conducted by the West-
inghouse Learning Corporation in conjunction with Ohio University. The
Westinghouse/Ohio study (1969) involved a sample of 104 Head Stare
centers scattered throughout the country. Among other things, the gov-
ernment-sponsored researchers asked the directors of the centers in the
sample to specify the degree of stress placed on eight different objectives.
About one-half of the directors ranked improvement in the child's sense
of self-worth, self-acceptance, and confidence as their most important
objective. On the other hand, 20 percent of the directors ranked the im-
provement of grammar and vocabulary as their highest priority goal.
Four of the remaining six objectives were ranked first by, at least one
director. It is evident, therefore, that no single statement adequately ex-

134 / programs for infants and preschool children

presses the priorities of Head Start, nor will any single set of criteria
serve as an adequate basis for evaluation

The child populations served by the centers also were found to vary
when examined by the Westinghouse/Ohio team One of the centers
studied enrolled children at a median age of 42 to 47 months, while three
of the centers reported comparable figures of 78 to 83 months of age
Thus it is not even entirely correct to specify Herd Start as being solely
for preschool children In general the children in the centers were found
to include an over representation of nonwhite youngsters with black clul
dren constituting more than a half of the full year program participants
and more than a third of the summer program enrollees Socioeconomi
cally about 58 percent of the full year children and 50 percent of the
summer enrollees were found to come from families with yearly incomes
under $4000 Fewer than 8 percent of the parents of Head Start children
were found whose own parents held jobs beyond the unskilled worker
category

A potentially important finding of the Westinghouse/Ohio study, dis
covered through interviews with parents concerning parent child relation
ships was that about 56 percent of Head Start parents seldom or never
play with their children This finding lends support to the widely held be
lief that the deficits observed in disadvantaged children may at least par
tially be attributed to inadequate stimulation

Assessment of the impact of Head Start is clearly a difficult task and
one that is still m its formative stages The Westinghouse/Ohio study, al
ready mentioned constitutes the most ambitious attempt to date to dis
cover what effects if any the project has had After selecting 104 re
presentative Head Start programs the Westmghouse/Ohio team chose
about 2000 children in these programs who were then m one of the first
three years of elementary school The children were matched with an ap-
proximately equal number of children attending the same schools who
had never been enrolled in Head Start Although the control children had
to be potential ehgibles for the program it was not possible to match
them perfectly with the children who had actually participated The con
trol group was found to be of slightly higher economic status and was
composed of children who were more capable than the experimental sam
pie this mismatch between experimental and control children necessitat
ed later statistical adjustments intended to compensate for the effects of
initial differences

The Head Start children and their controls were compared on a wide
variety of instruments including IQ and school achievement tests tests of
linguistic abilities self concept measures and questionnaires to evaluate
the child s attitude toward home school peers and society The children
were also compared on an inventory of classroom behavior that was

INTERVENTIONS CENTERED IN SPECIAL SETTINGS / 135

based on teacher ratings It was concluded from these many comparisons
that the Head Start children were not demonstrably superior to the con
trol sample in either cognitive or affective development The few scat
tered indications of a favorable program impact were all attributable to
children from full time as opposed to summer Head Start experiences
When findings were compared according to regions of the country, how
ever, the data did suggest that Head Start had positive effects on the
most disadvantaged children, notably Southeastern Negroes In their con
elusion, the Wcstinghouse/Ohio study group offered suggestions for nn
proving Head Start, including the proposal that summer programs be
eliminated and the suggestion that intervention might begin even earlier

in the children's lives

The Westmghouse/Ohio report has been widely criticized on a variety
of grounds White (1970) questions the sampling procedure by which
subjects were selected and comments on the possible invalidity of some of
the research instruments Much of the criticism leveled at the report is
concerned with the stat.stical procedures by which the data were mde
interpretable Campbell and Er.ebacher (1970) attempted to show that
the statistical methods used by the study group tend to bias the findings

such a way as to make the intervention look less effec iv

Head Start has also been defended on the pound . that

w T ,ho.,„o,,. t

of the program For example a a y positive rf

cates (1970) purports to show ^ ^ ^ whatever the

fects on the attitudes and publi p P admiUed that t h e direct and
worth of these conclusions, it in ^ ^ demonstrate d

pervasive benefits for children ? on Head Start do not elimi

The essentially negative ov h the network of centers

nate the possibility that some ^progr ^ chi]dren Certain Head

have provided demonstrab y substantial efforts to provide

Start facilities for example, a t otherwise receive no atten

mental health services to ch ‘ ldre " w ° , | t Outers have been able to
non In parts of New York City *e Head Statt Cen^ ^ projects

enlist child psychiatrists to act “ T , j ong range benefits of such

(Hotkins, Hollander, and MunkJ^hetang^ g^ ^ may
an arrangement remain to e extending the reach of the mental

readily be seen to facilitate the goa „ e as of the commu mty

health establishment to P re '' ,ou ^ , | tart project make it an important
The scope and diversity of the y( £ t J h at the determination of

one for study It should be evi ^ w j lcn dealing with so cast a

why effects do or do not occur r i to examine a more modest pro-
project For this reason “ the hom e

gram of preschool interventi

136 / programs for infants and preschool children

In the early 1960s Gray and Klaus (1965) established a program in
tended to prevent the progressive retardation often occurring in culturally
deprived children This program actually served as one of the models in
the planning of Head Start The group of children originally involved m
the Gray and Klaus study comprised 88 black preschoolers living in two
cities of a middle Southern state Gray and Klaus selected presumed high
risk children on the basis of parental occupation education income and
housing Most parents were unskilled or semiskilled workers whose family
incomes were below the poverty level The average parental education was
eight years of schooling but Klaus and Gray (1968) found that many of
the mothers were functionally illiterate In one third of the homes no
father was present

The 88 children in the project who were nearly four or just four years
old at the outset were divided into four groups One group of children (N
— 22) was pretested at entry in the study and then enrolled in a sum
mer school for three consecutive years after which tests were again ad
ministered In addition to the summer sessions the children in the first
group were visited at home weekly during the period when sessions were
not being held A second group of children (N = 21) received the same
type of enrichment experience as the first group but the intervention be
gan one year later so that each child was trained and visited for two in
stead of three years A third group consisted of 18 control children who
were tested at the same times as the experimental children but who re
ceived no special training Another control group was made up of 27
children from another city

The summer sessions provided for the two experimental groups were
conducted over a 10 week period each summer with five 4 hour sessions
each week Hence children m the first group had a total of 600 hours of
enrichment while children tn the other experimental group received 400
hours The summer session attempted to instill attitudes believed to be
relevant to later school achievement such as persistence and a capacity
to delay gratification The summer program also provided specific skills
such as spatial perception and concept formation The home visitor pro
gram was conducted by two trained teachers who attempted to stimulate
parental interest in the child provided materials and aided the mother m
caring for the child The home visitors also collected data on the child s
progress

The first reports from the project (Gray and Klaus 1965) gave defi
mte evidence of the positive shortterm effects of the intervention In
Figure B the four groups of children are compared in terms of mental age
(MA) a measure which in this instance is perfectly correlated with IQ
Group Tj is comprised of children who had their first summer experience
in 1962 as is indicated in the graph (Figure 2) this group immediately

INTERVENTIONS CENTERED IN SPECIAL SETTINGS / 137

gamed an advantage in MA over the other groups Group T z had its first
summer experience in 1963 and showed a gain similar to that observed
with group T x the previous year Following the summer of 1963, both of
the experimental groups had a higher average MA than either of the con
trol groups, T 3 and T t Moreover, the slope of the graphs for the two ex
penmental groups is steeper than for controls, indicating a more rapid
rate of mental growth bindings with respect to mental age were closely
paralleled by comparisons between groups on linguistic abilities

A follow up study (Klaus and Gray, 1968) was performed five years
after the initial intervention by which time the children had entered
school so that a broader range of evaluative instruments was appropriate
for assessing program effects Results were again encouraging The ex
perimental groups continued to hold their lead over controls on tests of
aptitude and language skills The trained children were also superior on
tests of readiness for academic work and on tests of achievement Fur
therm ore, the experimental children were less impulsive and had a more
positive self concept (although other measures of attitudmal stance did
not differ)

In 1970 Gray and Klaus (1970) published a third report on the prog
ress of children in the program which included the results of tests admin
istered to the children as late as their fourth year of school At this point
the effects of the intervention were less apparent The experimental chil
dren were narrowly, but significantly, superior to the controls on the in
telligence tests The experimental children were not, however, significant
ly superior to controls on tests of vocabulary and school achievement

138 / programs for infants and preschool children

These results were interpreted as reflecting the inevitable decay of gains
made through an early intervention consisting of relatively limited
periods of environmental enrichment.

An interesting additional finding was also reported in the 1970 study
—the siblings of the experimental children were found to have higher
IQ’s than the siblings of control children. These data led the authors to
suggest that the home visitor in the intervention may have produced ben-
eficial changes in the parents of the experimental children leading to a
“vertical diffusion” of positive program effects. Such speculation leads
naturally into the consideration of a final group of programs where the
home is the locus of the intervention, and the parents are sometimes in-
tentionally placed in the role of helping agents.

HOME CENTERED INTERVENTIONS

Home intervention programs are of two types: the first type brings
trained workers into the home to work directly with the youngsters; the
second relies on trained personnel primarily as educators to the parents.
Despite differences in approach, both types of intervention probably in-
fluence the way in which the parent-child relationship develops. It seems
virtually inevitable that the presence of a program in the family dwelling
will have effects on parental behavior, even where the parents may not
be required to participate actively.

A good example of a home-based intervention program using trained
personnel as change agents is that reported by Schaefer and Aaronson
(1970) . Through canvassing two lower socioeconomic neighborhoods in
Washington, D.C., a sample of 64 Negro male infants were selected. In-
fants were chosen whose families earned less than $5000 per year, and
whose mothers had less than 12 years of schooling and were unskilled or
semiskilled workers (if employed). Otherwise eligible children whose
homes were not suitable as a location were excluded. This selection pro-
cedure illustrates one of the limitations inherent in home-based programs;
crowded conditions, disruptive siblings, or poor physical environment
may all too often prevent intervention in the very homes where it might
be most needed.

The goals of the Schaefer and Aaronson program were to promote in-
tellectual functioning and language skills, toward the ultimate objective of
raising later academic achievement. Based on the belief that infantile be-
havior patterns, maternal behaviors, and mother-child relationships are
relevant to cognitive growth, Schaefer and Aaronson sought to evaluate
these factors as well as the actual intellectual and language development
of the children.

HOME CENTERED INTERVENTIONS / 139

The 61 infants were divided into an experimental and a control group
of 31 and 33 infants, respectivel) Initial differences were slight and
tended to favor the controls All infants were given intelligence tests at
14, 21, 27, and 36 months of age Ratings of mother and child behavior
were made only for the experimental group at intervals throughout the
training process and at 36 months

Beginning at 15 months of age, experimental group children received
one hour of tutoring fire days a tv eel. until the child reached 36 months
of age Control children received no special attention other than periodic

intelligence testing

The tutors were a carefully selected group of college graduates, many
hav ing regular jobs relev ant to their role m the program Interviews, writ
ten applications, and experimental background were considered m select
ing the tutors Part of the rationale for selecting a highly skilled group of
individuals was that development and assessment of the innovative pro-
gram would require workers with exceptional qualifications It was no
assumed that the service role itself would require so select a group of
people The tutors who were chosen received didactic anc 1™““*
training to augment them existing skills and experience Didacc «pen
ences included lectures, readings and discuss, ons Mum tri tnmg n
eluded observatton of infants in special settings practice
fants, and forays into the target community to actually ^t .he .nfan«
to be used in the study Schaefer and Aaronson emphas.red t h eir eff or „
to build and maintain a •.£££* -“3umr would be

non sponsored project Figure 3 is an

Methodology Specific Examples ,hey toed during the course

The tutors wrote up a number of successful Some of these are

of the experiment, and which t ey e contributing each

described or quoted here, along w„h the name of the tut

, i, J, the child has become familiar, are
A A number of ob|ects, with w i c ars and an imals, pencils

placed in paper bags These mig wtllch ,h e child must reach into

buttons, brushes etc A game is P'^ ed ' unseen The child is allowed

the bag, handle the ob|ects, and na name The tutor guides him or

to remove and play with those object^ ^ (Luc|IIe Bonks)

provides bints to enable hi

B Since the most frequently stated atm of the pro|ect has been to stimulate
verbal development, 1 have concentrated on singing in my presentation of
music 1 have selected a few songs which have simple words appea ing
melodies and rhythms and, most important, are repetitive I have repeat
these songs until they have been mastered by the babies
Two of the babies have expressed a strong preference for one particular
song In these caes, I have attempted to include the favorite song in ecrc
sngmg session, since the babies become very excited and responsive w
it is sung From this song, I have moved to less familiar songs, hoping t o
initial enthusiasm stimulated by hearing and singing a familiar song wi carr Y
oyer The babies appear to derive much satisfaction from their increas 9
familiarity with and ability to perform these songs

Figure 3 Exccipts from a Tutor s Log (OE 37033 A)

excerpt from one of the detailed logs kept by the tutors to describe th
activities with children This extensne accounting of interventive stra
has not been present in the reports of many of the projects aW* ‘ .

scribed thus the Schaefer and Aaronson research may be P ** 11
useful as a model for future work because it does pro\ide an exphci p

cedure to be followed

Although conducted in the home, the tutorial sessions did not requ
c acuvc participation of the mother Her participation was cnc0 terS
ST ~ exerted when she seemed reluctant Some mot*
vention ' ‘ ntCrest ln the KSS,ons and appeared to tolerate the

™ to m aU * e <he Pro ^ m "" ' P a >™ nt c;*

ess and ak ' modlers became acutely engaged in the tuton g

lhe ““m ^ sympathetic listeners 4

Aaronson 197 m *°" tCrm "“““““nt o£ program impact W ts

"ere snm.r.r, ,1 ! Senerally posuite The IQ’s of the tutore

Tests o[ , "J than tllose ot controls at 21. 27, and
'be tutored clul drenT e i° pmcnt administered at 36 months a s ^ ^
“"'e by the ch.ll"‘°. h f- SUpcnor U " as found ' h0 ". ev . er ’ * alliy of llc

— relit V sere correlat ed with ratings of the q 1

"hose mJ° nShip *^ e ST^atest improsement was fou*—-
"bile rli.w^ ^PP 631 ^ to be relam ely nonhostile t0 " ,

r disi nlcl

, - ««ue cniirire a PP eared to be relatnely f€l ,

idatn-iy 1 ! ' shose mothers were rated as hosule or ^

‘““alrdatnj, ’/ “ s Thus t,le ™pact of the intertenuon a"

mg y Slab * e patterns j AA,u\e 1 ^

affect T t n,la " d d « arg

Ap»>: ,lys ' tua "an
P aaetnng effort

- t'-'v stable patterns oYch^^^mg ^‘additoe^J,

"ttgument for inters entise approaches tn 2

more directly n * 1

to accelerate infant deselopment b> inter' €

HOME CENTERED INTERVENTIONS / 141

the mother child relationship was reported by Irwin (I960) Working
class mothers (not a poverty group) were instructed simply to read sto-
ries to their children for 20 minutes a day This process was encouraged
from the time the children were 13 months old until they reached 30
months of age Irwin’s criterion measure, the number of speech sounds
spontaneously produced by the children, revealed that, compared to con
trols, the experimental group children engaged in significantly more vo-
calization

A more ambitious program with a focus similar to that of Irwin s proj
ect is reported by Levenstein (1969) Levenstein sought to stimulate in
tellectual growth m preschool children by altering the mother child rela
tionship Her total sample consisted of 54 mother child dyads drawn
from public housing and of low socioeconomic status The children m the
dyads were either two or three years old when the intervention began In
the experimental group, consisting of 33 dyads, mothers were traine
interact with the child around verbally oriented play utilizing toys and
boohs supplied by the project A "toy demonstrator" came to the ; horn
regularly to model appropriate behavior for the mother The visits were
made over a seven nfonth period after which the children were retested
by using instruments that had been used in a pretest . j

Levenstein compared the experimental paup with two types of^n.rol
groups The first control group consisted of nine dy
home visits from a professional who expressed interest m the fam dy
did not suggest or model parent child interactions A jecond^cont^
group received no visits, but was tested at t e sa

"tE experimental group showed a

and vocabulary than did either of t le c0 ‘* children who were first

stein's expectation, however, the experl children who

seen wbeTthey were two did not benefit mcae o£

were three when the home v,sl ' s "“'' where the ear l,er intervention did
the findings of Gray and Klaus ( be observed , however, that

not produce differential resu ^ mvolved m terventions

both the present study and that o y ^

occunng earlier than in programs sue i as Levenstem’s project in

A final program to be consi n[ To affec , maternal behav

many ways, but adds one impor the home itself Where the

ior, Levenstein chose to sen a VI ^ ch must inevitably be a costly

visitor should be a trained worker, this aPP ^ & time Karnes , Teska,

one, since the worker can sene only one tam y s[r of bnng

Hodgins and Badger <^°> parent-child inter

mg the mothers into the proj

B Since the most frequently stated aim of the project has been to stimulate
verbal development, I have concentrated on singing in my presentation of
music I have selected a few songs which have simple words, appealing
melodies and rhythms and, most important, are repetitive 1 have repeated
these songs until they have been mastered by the babies

Two of the babies have expressed a strong preference for one particular
song In these caes, I have attempted to include the favorite song in each
singing session, since the babies become very excited and responsive when
it is sung From this song, 1 have moved to less familiar songs, hoping that the
initial enthusiasm stimulated by hearing and singing a familiar song will carry
over The babies appear to derive much satisfaction from their increasing
familiarity with and ability to perform these songs

Figure 3 Excerpts from a Tutor s Log (OE 37033 A)

excerpt from one of the detailed logs kept by the tutors to describe their
activities with children This extensive accounting of interventive strategy
has not been present in the reports of many of the projects already de
scribed, thus the Schaefer and Aaronson research may be particularly
useful as a model for future work because it does provide an explicit pro-
cedure to be followed

Although conducted m the home, the tutorial sessions did not require
the active participation of the mother Her participation was encouraged,
but no pressure was exerted when she seemed reluctant Some mothers
evidenced little interest in the sessions and appeared to tolerate the inter
\ention only because the program involved a small payment to participat
ing families Other mothers became actively engaged in the tutoring proc
ess and also sought out the tutors as sympathetic listeners

Results of the short term assessment of program impact (Schaefer and
Aaronson, 1970) were generally positive The IQ’s of the tutored infants
were significantly higher than those of controls at 21, 27, and 36 months
Tests of language development administered at 36 months also showed
the tutored children to be superior It was found, however, that the gains
made by the children were correlated with ratings of the quality of the
mother child relationship The greatest improvement was found for chil
dren whose mothers appeared to be relatively nonhostile toward the
child while children whose mothers were rated as hostile or disinterested
benefited relatively less Thus the impact of the intervention and the ef
fects of relatively stable patterns of child rearing were additive This find
ing substantiated the argument for interventive approaches that seek to
affect the famil> situation more directly

A pioneering effort to accelerate infant development by intervening in

HOME CENTERED INTERVENTIONS / 143

Table 2 Experimental ( N = 15) and Matched Control ( N = 15)
Groups, Stanford Binet and ITPA (Karnes et al , 1970)

Binet CA
(Months)

Binet MA
(Months)

Binet IQ

Vanable

Mean

Standard

deviation

Difference

V

Level o£
signiff
cance

Expen Expen Expen txpen

ment Control ment Control ment Control meat Control

ITPA Total
Language Age
Difference
Score (Months)*

Expen

37 9

38.3

3 92 345

04
0.24

1 £ 35.5

684 543

63
272

12 46 9 87

15 7
370

6.59

51

255

■To relate ITPA language age and chronolog.G.1 age and to compensate for dtght
differences tn mean chronological ages between groups a language 0 f "f” ^

was computed by subtracttng each child s^rono ogtcriage^ oId mtfi , (Ml

his language age score For example a ■ SCOIe of _ 4 m „„ihs All ITPA
language age score o£ 32 months «<*|wd sa>red telow , h c norms provtded for

.lata are presented in this form Ch.ldre ' [otal language age score (30 monUis)

the ITPA total were arbitartly assigned the experimental group and

This score convention was reputed to three mstances tn die expenmenta g

in seven instances in the matched control
b One tailed test

comparison with the sibling had a posmve ef

again found to be superior, sugg 8 Iy bee n more adequate

feet andthat the experimentalrnothershadno. [roi PJ others

parents before their training th K , an d their associates con

Unfortunately neither Levenstem or u h ago to allow for a

ducted their home focused interventions concluded on the basis of

post intervention follow up Schae er ( h t hat family centered

his review of early childhood interven 1 ^ positive effects Cer

interventions may be necessary to pr , tenn benefits are most likely

tainly, it is logical to change m the home envi

where the intervention produces Pf f h early hfe

ronment in winch the child - culation (Schaefer, 1970) on

- Fmdtngs (Karnes etttl . ^ ^ programs andjhe

the relationship between the environment ■ ,

breadth of their impact on the ch Qn program s as a means of

point concerning the value of ear y P _ r mmmunlty forces Much of the

point concerning f

gaining understanding of the opera

142 / programs for infants and preschool children

action The original sample consisted of 20 mothers whose children
ranged in age from 13 to 27 months with a mean of about 20 months A
control sample of 20 mothers was matched with the experimental group
m both maternal and infant characteristics One important difference,
however, existed between the experimental and control mothers The
control group mothers were not asked whether they would be willing to
participate in the training program Thus the control mothers may have
included women who would have refused the training because of disinter
est m the child or other factors To offset the possibility that an initial
difference between experimental and control mothers could account for
later findings six control children were added to the study who were the
older siblings of children whose mothers had agreed to enter the experi
mental training Test data on these older siblings was collected when they
were about the same age as the younger child would be when the mater
nal training was terminated It was reasoned that if the older siblings
were found to have been inferior to the children who had an opportunity
to be effected by the maternal training it would demonstrate that the
mother s willingness to enter training did not simply indicate that she had
been a more effective parent initially

The 20 mothers to be trained were divided into two groups and were
given $1 50 for attending a two hour lecture and discussion session each
week Lectures emphasized the importance of parent child respect posi
live reinforcement and patient step-wise teaching Parents were also ad
vised to be tolerant when the child did not choose to interact with them
In addition to the lectures the mothers were also provided with toys for
use with the children Training sessions were broken into seven and
eight month periods with a lapse of two months between semesters After
t le first training period five of the mothers decided not to continue and

tbprpfnrp ^ ° n t c ^ , ^ ren Program assessment was based

therefore on a sample of only 15 children whose mothers had participat

ed in a total of 15 months of

training From the standpoint of community

r 25 percent dr ° pom ral<: ma ’' be regarded as a negative find
ing tint does not appear in the formal test results

Results of .men, genre and language testing done on the children of the
trained and untrained mothers following the intervention period showed
U,e children of trained mothers to be s.gn.Bcantly superior in both tests
Table 2 shows a comparison between the experimental group and the 20
nonsib hug controls on the Binet intelligence test and the ITPA language
test The chronological age of the children ,n the two groups did not differ
significantly but mental age (MA) and language age of the children of
trained mothers was significantly higher (language age is shown as a devia
lion from the general test norm so that the negative score indicates that
both groups were still subpar but the experimental group was less so) In

REFERENCES / 145

ence and later maladaptation The programs for young children also
show that primary prevents e efforts may have a positive rather than a
negative emphasis In Caplan’s (1964) terms, the intervention may be
aimed at providing appropriate "supplies” when they are needed, in con
trast to the goal of removing an interfering disease entity Finally, the
programs described illustrate the notion that effective early intervention
need not be restricted to improving psychological functioning directly,
programs that provide the person with skills for meeting the demands of
the society more successfully are assumed to increase thereby the hkeh
hood that the individual will be psychologically adequate

Many of the projects cited m this chapter offer the promise that effec
tive and practical programs of early intervention are possible Also, it is
clear that most efforts to date have fallen short on issues of effectiveness,
reach, or ease of implementation Despite this failure, the value of contin
ued research in this area cannot be overemphasized, given the worth it
may have m helping us to identify the effects of varied environments on
young children Ultimately, an understanding of these effects might per
mit the community mental health worker to predict with confidence what
changes in the environment will reduce the incidence of human dysfunc
tion Without a systematic exploration of the effects on the young o in
duced variations in community processes, the preventiomst may ie
doomed to a future of building his plans on hopes guesses, an prayers

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Hellmuth (Ed), Disadvantaged child Vol 3 «

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Dennis W , 8. Dennis, M G Infant development un erm m i Mmogra pht,

practice and minimum soaal st.mulat.on Genet, c rsycn gy

1941 ,23, 149-155 preschool program for culturally

Gray, S W & Klaus R A An experimental p ?

deprived children Child Development, , ' seventh year report

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Child Development, 1970, 41, 909-92 psychiatric reports of

Hotkins, A S, Hollander, L, & Mim* » v ^ ua Disadmnta ged child Head
Head Start programs In J Hel mu V*) ' Wash Spea al Child Publ.
Start and early intervention Vol 1
cations 1968 Pp 137—172

144 [ programs for infants and preschool children

research on the impact of environmental deficiencies has been essentially
observational, for example the work of Dennis and Dennis (1941) with
institutionalized children It is likely, however, that observational re
search can only suggest but never prove, how particular environmental
factors affect development This is because the possible variations in nat
ural environments are so numerous that it is virtually inconceivable that
one could ever find two settings differing in only one respect and, hence,
permitting definitive conclusions as to the impact of a particular circum
stance Observational research must, therefore, leave problems in decid
mg where to lay blame and to attempt modification For example, the ob
servation that infants in institutions do poorly in a number of respects
permits a multitude of plausible explanations poor genetic makeup for
children who are institutionalized prenatal problems in cases where the
mother must give up the child poor diet in the institution, institutional
sameness, lack of affection from caretakers lack of adequate educational
experiences and so on Interventive programs, on the other hand, by in
troducmg controlled variations into children s environments may provide
solid clues as to the importance of various environmental factors

Consider the findings of Skeels and Dye that infants raised by retarded
women could show intellectual gains over their performance under insti
tutional care These results strongly imply that cognitive growth in mfan
cy is not mainly dependent on the ability of the caretakers to model highly
intelligent behavior Or consider the findings of Karnes et al that chil
dren with relatively caring mothers gain more from a stimulation pro-
gram than do children with less concerned mothers, the clear implication
emerges that the emotional tone of the parent child relationship may in
teract with the availability of learning experiences in determining whether
children develop optimally The interventive programs described in this
chapter others not mentioned and, hopefully, those yet to be attempted,
may ultimately derive their greatest worth from the understanding to be
gained about environmental forces by synthesizing the findings of numer
ous efforts to modify specific experiential factors through programs of
applied research

CONCLUSION

The programs directed at infants and young children provide illustrations
of se\ enl principles that are gaming acceptance in the field of community
psychology First, these programs reflect the assumption that intervention
is best attempted before manifest signs of psychosocial disturbance are
eudent This assumption rests on tile belief that high risk populations can
be identified on the basis of observed relationships between early expert

6. primary prevention in the schools

The school oilers a promising operating “ * e d ^f c uon Nascent
ed in reducing the and, hopefully

problems may be spotted m j the next chapter we shall

eliminated through appropriate lint d, I„ this chapter
provide examples of this secon ary P more am bitious goal, that of re
we consider attempts to pursue DSVcho logical disturbance Stated post
ducing the original incidence o P Y * ^ dlscu5se d is to make the
tively, the common goal of the p ] ^ wldl the resources that will

schools more effective m provi in S ate human being

help him develop into a psychosocially a 4 rests on the assumption

The pursuit of the goal of primary than a community clinic

that the school is more attractive ^ ^ force m the child’s life that
The school experience is assumed thc challenges of exist

has the potential to prepare him * a „ nre cogn.zed, the school

ence Although its influence may be indirect

146 / programs for infants and preschool children
Hunt, ) McV Intelligence and experience New York Ronald Press, 1961
Irwin, O G Effect of systematic reading of stones The Journal of Speech and
Hearing Research, I960, 3 , 187-190

Karnes, M B, Teska, J A, Hodgms, A S, & Badger, I D Educational
intervention at home by mothers of disadvantaged infants Child
Development, 1970, 41, 925-935

Kirschner Associates A national survey of the impacts of Head Start centers on
community institutions Report prepared for US Department of Health,
Education and Welfare, 1970

Klnus, R A , 8. Gray, S W The early training project for disadvantaged children
A report after five years Monographs of the Society for Research in Child
Development, 1968, 33, 1-66

Levenstem, P Cognitive growth in preschoolers through stimulation of verbal
interaction with mothers Paper presented to the 46th annual meeting of the
American Orthopsychiatnc Association, New York April 1969
Froience, S, 8. Lipton, R C Infants in institutions A comparison of their
development with family tnfants during the first year of life New York
International University Press, 1962

Rheingold, H L The modification of social responsiveness in institutional
babies Monographs of the Society for Research in Child Development, 1956,
12 (2) (whole)

Rheingold, H L , 8. Bayley, N The later effects of an experimental modification
of mothering Child Development, 1959, 30, 363-374
Schaefer, E S Need for early and continuing education In V H Denenberg
(Ed) , Education of the infant and young child New York Academic Press,
1970 Pp 61-82

Schaefer, E S , 8. Aaronson, M Infant education research project implementation
and implications of a home tutoring program Unpublished manuscript, 1970
Skeels, H M Some preliminary findings of three follow up studies on the effects
of adoption on children from institutions Children, 1965, 12, 33-34
Skccls, H M , 8. Dye, H B A study of the effects of differential stimulation on
mentally retarded children Journal of Psycho asthenia, 1939, 44, 114—136
Spitz, R A Hospitalism An inquiry into the genesis of psychiatric conditions in
childhood Psychoanalytic Study of the Child, 1945, 1, 53-74

PRIMARY PREVENTION IN THE SCHOOLS / 149

introduce sex education into the schools Some parents have argued, and
not without impact, that the school must inevitably convey a value orxen
tation toward sex in attempting to treat the subject even a highly factual
and mechanical presentation, by its omission of moral and ethical consid
erations implicitly provides children with an attitudinal stance Where
parents hold strong beliefs that sex should be treated within the context
of a particular ethical framework, some are bound to feel threatened by
any program, however strong an attempt is made to find an approach that
is minimally offensive As in the example of sex education, any primary
preventive effort m the schools could potentially be regarded as offensive
by parents who do not share the orientation of the interventionist A sec
ond related area of community concern is whether environmental engi
neering may be objectionable in principle, even where the general goals
seem acceptable A civil libertarian might well hold that the schools al
ready do too much to level and standardize the functioning of their stu
dents Might not the well intentioned psychologist only worsen this prob
lem by giving educators the means and motivation to make students con
form to someone’s ideal of “mental health ’?

There is still another perspective from which the community or seg
ments thereof may oppose primary prevention efforts o ™ anycl ’
the school exists mainly, if not solely, to impart socially usefu l skills and
information to children Goals of emotional growt ave ^

seen as inconsistent with the primary task of t e scioo oelC aI

sometimes been alleged that vaguely defined objectivesofpsychokpc
development are actually invoked to rationalize the adore o£ educators
to fulfill their true mandate of imparting specific knowledge

The community concerns cited above cannot be d— 1

They demand a careful consideration of t e , P ° b “ benefits against sub
based primary prevention and a weig mg . _ primary pre

stantial objections The most obvious benefit of in ^reached^y

vention in!o the schools is that virtually everyone might ^ reac^ J
such programs Insofar as the community, psy„ c ^ B environroen tally re
mate aim the maximum reduction of location is now avail

lated psychological disturbance no more ® prevl0 usly noted is

able for directing his efforts A seco personality development of

that the schools already inevitably shape *e J* ^ by the

children In response to the citizen w o , (i|a( schoo l s can either

interventionist in the school it has ^ unknown effectiveness

control children through unsystematic e tested methods, the psy

or through rationally planned an ^P 1 ther case (Madden 1972)
chological impact of the school 1S r ^ a 1 jnten ention may be viewed as
Clearly, from this perspective prev fa paren tal wishes than exist

less potentially destructive and conflictf P

148 / primary prevention tn the schools

must inevitably affect the way the student regards himself his abilities
value as a person, and chances of success (Mosher and Sprmthall
1970) From this perspective the function of the school as a place of
learning cannot be separated from its function as a place in which the
personality is formed (Biber 1961) The further implication of this posi
tion is that the school as an institution must be engineered to serve the to-
tal needs of its students if it is to affect their psychological well being op-
timally

In maximizing the positive impact of the school on psychological de
velopment the community psychologist faces two tasks first, he must de
termine or hypothesize what types of experiences are likely to promote
the acquisition of skills for effective living Second, the preventionist
must act as a change agent for a societal institution that has been
molded by the traditions biases philosophies and politics of the society
m which it exists The social scientist cannot be effective if he enters the
school with the naive belief that he can or should totally reshape it in line
with his own ideals

To some extent the community psychologist must always alter estab
hshed institutions when he attempts to intervene With respect to primary
prevention in the schools however he encounters particularly serious dif
ficulties Primary prevention is not directed at the existing dysfunctions
that may often motivate the educator to seek solutions Further, the inter

vention may seem burdensome or threatening to school workers whose
goals do not necessarily include striving to provide for positive mental
health (Caplan 1961) Teachers may be poorly trained m personality
development overburdened and prompted to concentrate primarily on
students who perform readily within the existing school structure (Bower,
1961) The difficulty of instituting primary prevention programs in
schools is attested to by the numerous efforts at intervention that have
been rebuffed or quickly killed It has even been suggested by one work
er (DeCharms 1971) that intervention as such is actually impossible,
since only changes that school personnel perceive as originating with
themselves can be expected to persist

Aside from the questions and difficulties raised by the nature of the
school as an institution the preventionist must also come to grips with
concerns that reside in the community at large A central issue often en
countered is whether the school should attempt to shape the personality
development of children or whether intentional efforts in this direction
should be the prerogative of parents This issue may encompass two sepa
rate types of concern On the one hand community members may fear
that psychological engineering in the schools will foster developments in
children that offend parental beliefs or thwart their childrearing objec
lives This issue has been salient in recent years with regard to efforts to

TROCRAMS WHICH EMPHASIZE TOTAL SCHOOL ATMOSPHERE / 151

PROGRAMS tVHICH EMPHASIZE TOTAL SCHOOL
ATMOSPHERE

The common feature of programs in this category is that the interventions
are aimed at altering the school setting in a variety of interrelated ways
with the objective of creating a total environment that promotes adequate
human development. The basic premise of one such program, the Bank
Street Project, exemplifies the assumption fundamental to projects of this
type: “That it is necessary to formulate a program through which mental
health principles will be infused into every school process and relation-
ship” (Biber, 1961, p. 348). Given this objective, it is obvious that pro-
grams in this category involve a coordinated set of specific actions that
will presumably have a beneficial cumulative effect. The specific inter-
ventions in a given setting will vary according to the nature of the exist
ing institution and the community it serves. For these reasons, projects of
this type are often better defined by their stated goals than by a single ac-
tion strategy or set or techniques. _ . . ,

The Bank Street Project stands as a pioneering effort in the t
school approach. The Project, based at the Bank Street CoIle f ^ du '
cation in New York City, involved an ongoing effort to -integrate ■ «*«
and action (Biber, 1961) . Its philosophy rests on the
educators like Dewey and the psychodynam.c P^^onahty theon ^ hke
Freud, and the viewpoint ol 20th-century humanism (B.be. ,1961 . The

psychological goals self and other,, (3)

tive feeling toward self, (2) realistic pc ^ ( k \ indeoend-

relatednesfto people (4) related,**

ence, (6) curiosity and creativity, an ( ) descr ibed and given a ra-
Techniques for achieving these goa s ave ^ ^ environme nt, Biber

tionale. For example, to increase op nbservation of potentially

(1967) ha, suggested giving children guided oblation P°

fascinating events such as the c ™ 5 ™"“^, ative in implementing its phi-
The Bank Street team has bee facilitate the infusion of men-

losophy. Projects have been undera thr0 ugh group consultation with
tal health principles into existing . of establishing and test-

teachers and parents. Tlowever e req uires 6 the creation of a school br-
ing the Bank Street approach, whicn q , 96 i) , has yet to be

tegrally structured around the P ’ ^ , pss am bitious efforts to affect

tegrally structured around the p i° s P ^ am bitious efforts to affect
achieved. Indeed, it is not clear 1 a ,, _ n (19 67) asserts that the in-
existing schools have had muc impa » limited to a few private

fluence of the Bank Street program has

schools. f th{ . Bank Street approach must rest

Given that the ultimate test of the «

150 / primary prevention in the schools

ing approaches that already shape growth, but without the benefit o£ a
public plan or assessed effect Indeed, because the behavioral scientist is
obliged to make known his goals and methods, it might be argued that he
poses less of a threat to civil liberties than do those who shape behavior
without acknowledging (or perhaps even realizing) that they are doing
so. A final issue concerns the question of whether primary preventive ef-
forts enhance or threaten the educative function of the school. As we
show in several of the programs described in this chapter, the goal of
helping schools to effectively teach culturally valued skills can be an inte-
gral part of the prevention program. From the positive stance of promot-
ing mental health, the acquisition of learning that promotes later social
adaptation may be viewed as essential. Thus, in answer to those who re-
gard mental health programs as an interference with the true objectives of
the school, it may often be possible to demonstrate that the innovative in-
terventionist shares the concern that the school experience be education-
al, in the narrow sense, as well as beneficial in a broader psychological
context.

In the final analysis, it may be necessary for citizens and psychologists
alike to suspend judgment on the worth of primary prevention projects in
the schools until more data are available. Meanwhile, however, the ad-
versary role taken by many community members may actually serve a
useful purpose by requiring the interventionist to take a true community
perspective. Any community in which substantial numbers of people are
interested enough to oppose programmatic efforts provides the mental
lea 1 1 wor er with the impetus and means for examining the general via-
bility of his approach. Consistent with the model of public health medi-
cine, an intervention cannot be deemed truly useful unless it can provide
ne ts on a \\i e scale. Projects that elicit community resistance to the
extent that they cannot be implemented or quickly disappear enable us
earn ot i a out our techniques and about the nature of the communi-

Whatever the philosophical and practical problems of initiating inno-
ame primary prevention in the schools, obviously the specific nature of
the program will be a primary factor in its acceptability and effective-
ness. The programs m tins chapter exemplify a variety of approaches dif-
fermg wtdely in their assumptions, goals, strategies, and methods. For
purposes o organization, these examples are grouped according to which

a ,rAi°. n ' 00l . C " V r nmCnt ,1,c ? primarily ,o influence. Roen
(1967) has distinguished between programs aimed at altering the general
atmosphere of the school and those that focus on alterations in the school
curriculum. To these tsvo categories a third will be added in this chapter
to include projects aimed at altering the basic methods of teaching and
behavior control.

A Sources of Motivation Teachers

Enjoyment of spontaneity and curi
osity of children

Sense of competence derived from

depth and vigor of children's response

to learning activities

Sense of personal worth derived from

choice and initiative afforded by ad

mmistrator

Identification with school's leadership
position in the profession

Pride in high achievement scores at
tamed by children

Ability to control and discipline valued
highly as part of sense of competence
Dependence on administrator's ap-
proval as measure of competence
Opportunity for extra classroom acfiv
ities

5 Encouragement of

Autonomy extended to teachers as
part of genera! view in which the In
dividual's independence and initiative
is highly valued

Teachers encouraged and supported
in innovative, creative approach to
curriculum

Teachers made participants In some
aspects of decision making for school
as a whole

Teacher Autonomy
Autonomy more a by product of mini
mal supervision and absence of com
mon value system

Teachers expected to follow a directed
course in implementing objectives as
interpreted by the administration

; pmnhas , s of schools on modem traditional

Figure 1 Differences in educational P
:ontinuum (Minuchin et a! 1969)

.Up schools were not altogether well
ground It is clear, however i class of the student popula

matched on variables other than variables arose from the

tion The most stnkmg fa.lure to evaluated as fall.ng to

fact that no publ.c school could be conUmum Th us the study includ
ward the extremely modern en , school it is conceivable that

ed three public schools and a smal p ■ dren in the m0 st modern

the dist.ngu.shmg characteristics ot u ^ (s to place them in a

school were related to the factors tIie sc hool itself

private institution, instead of to the e ecK o orkers focused tlieir

Within the four schools M "'“ , The children selected it ere studied

attention on 105 fourth grade children d through [hc use o

quite intensively, with in parental informants, and

school informants direct classroom observ The great

test data collected tn the course of five ^ ^ summanra ..on, so
wealth of data collected by the . , 0 primary prevention can be

that only a few of the findings most releva

152 / primary prevention in the schools

the unrealized and lofty goal of creating a totally new school, the Bank
Street team has performed research that provides less direct and less con
elusive evidence of the validity of its philosophy In a naturalistic study,
Minuchm, Biber, Shapiro and Zimiles (1969) sought to compare the ef
fects on children of existing schools differing in then degree of resem
balance to the Bank Street ideal The research team carefully selected four
schools that were adjudged to fall at different points along a continuum
from * modern ’ (best exemplifying the Bank Street philosophy) to tradi
tional Figure 1 shows some of the specific differences in educational em
phasis that were the criteria for evaluating schools on the modern tradi
tional dimension An attempt was made to select schools that differed in
educational philosophy, but served pupils of similar socioeconomic back

1 Stimulation of I;
Active exploration and discovery by
child

Child s ability to formulate and search
for varied solutions to problems
Sustaining critical questioning and
probing of ideas

Mastery through child's ability to dis
cern relationships among facts and
learn to deal with higher order con-
cepts

2 Variety of
Creative expression is integral to Intel
lectual development
Variety of media for expressive activi
ties

Developing techniques to integrate ex
pressive and analytic modes

ellectual Processes

Direct transmission of information and

skill from teacher to child

Teaching devices that raise teaching

and learning efficiency

Learning tasks with detailed directions

for children to follow

Amount and rate of mastering factual

information

Tendency to drift from pursuit of ideas
to moral precepts

Learning Modes

Creative arts are supplemental to aca
demic program

Creative activities as skill subjects
Reliance on the verbal mode as the
proper instrument for learning

3 Sources of Motivation Children

Stimulation of interest and self invest

ment In learning activities

Use of techniques for making learning

individually meaningful and satisfying

Concept of a school climate that

matches qualities and impulses of chil

dren

Use of established symbols as measure
of accomplishment

Use of an approval disapproval code
of evaluation

Encouragement of comparative com
petitive processes

4 Sources of Motivation Teachers

Enjoyment of spontaneity and curi-
osity of children

Sense of competence derived from

depth and vigor of children's response

to learning activities

Sense of personal worth derived from

choice and initiative afforded by ad

mimstrator

Identification with school's leadership
position in the profession

Pride in high achievement scores at-
tained by children

Ability to control and discipline valued
highly as part of sense of competence
Dependence on administrator's ap-
proval as measure of competence
Opportunity for extra classroom activ-
ities

5 Encouragement c
Autonomy extended to teachers as
part of general view in which the In-
dividual's independence and initiative
is highly valued

Teachers encouraged and supported
in innovative, creative approach to
curriculum

Teachers made participants In some
aspects of decision making for school
as a whole

Teacher Autonomy
Autonomy more a by product of mini
mal supervision and absence of com-
mon value system

Teachers expected to follow a directed
course in implementing objectives as
interpreted by the administration

Figure 1 Differences m educational emphasis of schools on
continuum (Minuchui et al 1969)

modem traditional

. „ that the schools were not altogether well

ground It is dear, howeve , soaa , cIas5 o{ the student popula

matched on variables other than r var]ab ] es arose from the

non The most striking failure to ^ ^ (ha( was evaluated as falling to-
fact that no public school coul contiml um Thus the study tncltid

ward the extremely modern end o r]yate sc hool, it is conceivable that
ed three public schools and a sma P children in the most modern
the distinguishing characteristics o j licit parents to place them in a

school were related to the £a “° fS he effect s of the school itself
private institution instead oft an( i hls co -workers focused their

Within the four schools. Mi children selected were studied

attention on 105 fourth grade children hercd lhrou gh the use o

quite intensively, with oraia “" non, parental informants, and

school informants, duectdassroont obse^ The great
test data collected in the ^course means de fies brief summar.rat.on, so
wealth of data collected by the* ^ IO primary pretention can be

that only a few of the findings most re

152 / primary prevention in the schools

the unrealized and lofty goal of creating a totally new school, the Bank
Street team has performed research that provides less direct and less con
elusive evidence of the validity of its philosophy In a naturalistic study,
Minuchm, Biber, Shapiro, and Zimtles (1969) sought to compare the ef
fects on children of existing schools differing in then degree of resent
balance to the Bank Street ideal Tiie research team carefully selected four
schools that were adjudged to fall at different points along a continuum
from modern (best exemplifying the Bank Street philosophy) to tradi
tional Figure 1 shows some of the specific differences in educational cm
phasis that were the criteria for evaluating schools on the modern tradi
tional dimension An attempt was made to select schools that differed in
educational philosophy, but served pupils of similar socioeconomic back

1 Stimulation of Intellectual Processes

Active exploration and discovery by
child

Child's ability to formulate and search
for varied solutions to problems
Sustaining critical questioning and
probing of ideas

Mastery through child's ability to dis
cern relationships among facts and
learn to deal with higher order con-
cepts

Direct transmission of information and

skill from teacher to child

Teaching devices that raise teaching

and learning efficiency

Learning tasks with detailed directions

for children to follow

Amount and rate of mastering factual

information

Tendency to drift from pursuit of ideas
to moral precepts

2 Variety of Learning Modes

Creative expression is integral to inte!

lectual development

Variety of media for expressive activi

ties

Developing techniques to integrate ex
pressive and analytic modes

Creative arts are supplemental to aca
demic program

Creative activities as skill subjects
Reliance on the verbal mode as the
proper instrument for learning

3 Sources of Motivation Children

Stimulation of interest and self invest

ment in learning activities

Use of techniques for making learning

individually meaningful and satisfying

Concept of a school climate that

matches qualities and impulses of chil

dren

Use of established symbols as measure
of accomplishment

Use of an approval disapproval code
of evaluation

Encouragement of comparative com
petitive processes

PROCRAMS WHICH EMPHASIZE TOTAL SCHOOL ATMOSPHERE / 155

dents at two high schools would differ as a function of different rates of
student turnover at the two institutions Kelly identified a 'fluid ’ school
with a turnover rate of about 42 percent and a “constant ’ school with a
rate of only 10 percent Differences in turnover rate were primarily at
tributable to greater geographical mobility of the families served by the
fluid school Attending only to this known difference between the schools
(although other differences were also known to exist) , Kelly was able to
make several predictions that were supported by observational and stu
dent interview data Evidence supportive of predictions included the find
mgs that new students were more readily accepted in the fluid school,
that personal development was more valued in this setting, and that stu
dent groups were more stable and inviolable m the constant school Kelly s
data also showed that the school administrations, as aspects of an in
terlocking system, differed in their operating styles and professed stand

aras

The practical implication of Kellys preliminary conceptualizations
have already stimulated efforts to approach the task of primaij prev en
tion from an ecological perspective Carroll, Bell Minor, and Brecier
(1973) have attempted to maximize the position impact of inner ci y par
chial schools in Philadelphia by an intervention focused upon “ r
key interlocking psychological systems

than upon individuals per se (p 1) A parti i j ‘ ,

to promote positive relationships between children and teachers de pirn
the fact that the children live much of their lives in «
which is, in many ways in conflict with the school as an
tern Toward the goal ot affecting both tcac teachers and children
ly, the researchers organized sraa1 ' S™” 1 ” ‘ . the children while teachers
in which consultants encouraged discu consultants aided teachers

acted as participant observers Similarly («»» The
in establishing systematic contacts vv it pare^ facllintors so

mental health team trained teac perpetuating the

as to bring into the ecosystem of ^

new programs after the W.tlidr v 1 f |he deploymem of the

A recent report by Minor ( ) emphasis from the work

ecological model in a way that differs S ,( lc ecological

of Kelly and h.s associates Wta« Ke , . intcncnc primarily

of Kelly and his associates ^tempted to intcncnc primarily

significance ol the total common > c(M , or j;ers in the Philadelphia
with school personnel, Minor am bcm ccn the school and ihc

school system offered themselves as 'tanom belt * ^

other subsystems in " h,ch ‘ '^“jn^onlacteil the family of a child
describes how a community . carrying pictures that the teach

who had been found by the teacher be ^ ^ ^ to; , clllcr a

cr considered pornographic. The w*as operating ami to

picture of the total ecosystem in which

154 [ primary prevention in the schools

included here Essentially the basic hypothesis that the psychological
characteristics of the children in the different schools would differ re
ceived moderate support Children in the most modern school were
found for example to be better able to accept their negative feelings and
were less future oriented than their peers in the more traditional schools
It was not found that the cognitive skills of the children were directly re
lated to the modern traditional dimension but if anything the data sug
gested that children in the traditional schools achieved better on
standardized tests Children in the most modern school consistently scored
below the other groups on tests of intelligence and achievement although
the authors attribute this difference to test taking attitudes and motiva
tion In the interpersonal sphere some evidence was collected which sug
gested that the character of the school affected the way the children saw
others however the findings must be evaluated with regard for the nu
merous failures to find differences Sexual identity was another area stud
led where school philosophy seemed to have an impact Children in the
most modern school continued to evidence sex linked personality fea
tures but these children were less likely to exhibit the stereotyped sex
role distinctions than were children from the more traditional schools
The complex findings of Minuchin and his associates certainly do not
provide unequivocal evidence that a particular school philosophy is pref
erable from the standpoint of promoting mental health The research
does not prove that the future lives of children in the more modern
schools will be happier or more stable than the lives of children receiving
a more traditional educational experience At best any conclusions must
combine the evidence presented with the observer s own biases as to what
childhood traits are desirable In addition the naturalistic approach taken
by Minuchin et al does not speak to the issue of creating or modifying
schools so as to produce the desired effects Zimiles (1967) in evaluating
the research argues however that studies of this type will ultimately
guide us xn the shaping of environments when it becomes technically pos
sible better to identify influential factors and their interactions
The Bank Street approach rests on a broad conceptualization of the
school emphasizing the educational philosophy around which the institu
tion is built A different but similarly broad model for conceptualizing
school characteristics is to be found in the work of Kelly and his asso
ciates in Michigan By drawing on the biological concept of an ecological
system Kelly (1968) has adapted several principles to make them appli
cable to social environments (1) functions within a social unit are inter
dependent (2) resources within a social system may be recycled and
emerge as a productive output or may be absorbed by the system itself
(3) the environment affects styles of adaptation and (4) natural com
mumties e\olve with changes in membership and function occurring
Operating from these principles Kelly (1967) sought to predict how stu

PROCRAMS WHICH EMPHASIZE TOTAL SCHOOL ATMOSPHERE / 157

The operating style of the consultants, once they gained acceptance,
was based on the observation that teaching is a lonely profession where
the teacher must generally rely almost solely on his own resources, even
in situations for which he has little preparation. The consultants made
themselves available to the school staff as trustworthy, politically (school
politics) disinterested fellow professionals with a useful new perspective
to provide. Indeed, the consultants primarily viewed their own helping
skill in terms of their ability to aid teachers in changing their perceptions
of problem situations. It was hoped, and anecdotally verified, that when
teachers could gain new perspectives on the problem that their own re-
sources would enable them to solve the dilemma and effect a solution.
Note that in contrast to the traditional role of the psychologist i,n the sys-
tem, the program consultants did not act as “stand-ins to take o\er vdicn
the teacher had "failed.” The consultants labored to become a useful part
of the working team in the school, sympathetic to the mental health needs

of pupils and teachers alike.

It might be readily inferred that the consultants did not always, or e
frequently, serve as true primary preventionists, t te case matc ™ j 1 ,
vided by Sarason et al. suggests that secondary pro enuon vns ^
ten the need for which the consultants were sough- c 'f ' ji(

were instances in which the consultants intervene " xrc disturb-

nation was not necessarily created by an ex.st.ng psyc
ance in the child. Figure 2 represents an example of a sttt.at.on where

Example 6. A first-grade child was ° Ycobical fashion,

would sometimes move slowly and de Y tending

making everyone wait on her. She also “ tired. The con-

to daydream away her time, or comp ai experienced much illness

sultant and teacher both knew that the hit e 9 1 pr[m a donna.

,n her family and that, in fact, in "er awn household d,e was P ^ ^

The teacher, a highly competent in ■ , ilh rog e to this little gnl On o

prima donnishness, found herself reac ing esked for a conference,

afternoon, seeing the consultant in t e ui ' ^ f e p w ; { h the little G lf *

during which she expressed the frustration expression of her feei ng*.

After having permitted herself the rather , 0 the child and

the teacher found herself amazed °* ,he . " V ^ cons „|tont was able to be

the teacher found herscii The consultant wo# _

expressed guilt and shame about I « 51 “ ,hroughout the rest of the m-m t e
quite supportive of her In the situation, an ^ ^ lh „ one occasion

teacher never again felt quite so <* rcs —

rt it. I**. P

“ 1 , 1 wilH 2 irJltXT i

Figure 2. Example of comulunl * *

156 / primary prevention in the schools

formulate a plan of action that considered the interlocking aspects of the
home and school situation

Although the ecological model has yet to be widely applied this con
ceptualization may have implications for an issue that we have already
discussed From an ecological viewpoint school interventions may be
doomed to failure if they are not planned with attention to the repercus
sions that any program will produce throughout the system Thus preven
tive efforts that offer great promise may be impossible to implement or
sustain if their effects on key subsystems m the institution or community
are negatively regarded One possible response to the danger that a pro-
gram will fail because it ignores or offends elements of the scholastic
community is to design multifaceted programs which expand over time as
resistances diminish and demand develops The remaining programs in
this section exemplify this strategy Naturally those that evolve as a func
tion of the unique characteristics of a particular school will inevitably
lack the conceptual unity of an approach like that of the Bank Street Pro-
ject In fact the projects to be discussed are sufficiently diverse in their
interventive actions that they cannot be wholly encompassed under the
category of primary prevention Many of the specific functions of the
workers in these programs would best be described as having secondary
or even tertiary prevention as their goals

work , of Sarason Levine Goldenberg Cherhn and Bennett
(1966) provides an excellent example of a project shaped by the dis
cerned needs and tolerances of the school settings to be served Sarason
and his associates wished to mount interventive efforts in elementary
chools located m the New Haven area Their first steps toward this goal
re cautious ones based on a recognition that the services they were
preparing to offer would not be universally welcomed within the mstitu
” ,““ ns5 were arra "S ed teachers and administrators to intro
outside r more importantly to gain a sense of the way m which the

consul ants were viewed by the school staff Through these meet

n«„ u „ d a "d ' eam WaS ab ' e ‘° ‘ dem,fy the P r ° bl «ns m entering the
m Utut on and to determine their next move toward developing a helpful

consul, m , S d °" e observatl °ns made m mitial meetings the
consultant team moved next into a passive observer role m the class
rooms By observing the classes the consultants hoped to help school per
sonnel recognize the willingness of the consultants to learn how things real
Iy happen in the actual frontline work of the teacher The obsecration
sessions in some instances led to rapid breakthroughs in staff acceptance
as occurred when a consultant was able to help concretely a teacher and
principal confronted with a child throwing a frighteningly impressive tem
per tantrum In most cases however acceptance was gamed less dramati
cally as a few teachers would begin to approach the consultant for help

TROCRAMS AIMED AT CURRICULUM IMPROVEMENT / 159

the theories of crisis intervention (the concept being that teachers seeking
consultation should be viewed as people in crisis) and had ready access
to supervisors Despite this preparation, Iscoe et al found that their stu
dents c\pcrienced man> problems in adapting to their new role, partially
as a result of their new role, partially because of their preconceptions
about the ua> a psychologist must function

The child behavior consultants functioned primarily as helping agents
for the school personnel, direct service to children was not a major part
of their function Consultants is ere however given latitude to vary their
style.of operation according to the characteristics of the school in which
they were placed Preliminary findings of the two year program showed
that about 600 consultations had been conducted, with initial differences
between the rate of utilization by schools in different districts In particu
lar, the schools servicing minority groups solicited fewer consultations
About 41 percent of the school personnel eligible for the service across
districts did make one or more uses of the consultants Of particular re e
vance to this chapter is the finding that almost two thirds of the chl1
for whom assistance was sought did not display major P^holo^al
problems, thus the program was not mainly useful fm ,t
tion A particular value of the program m Texas wou .

demonstrates consultants can enter the schools can be utilized with ^rea
sonable frequency, and can service the needs of children no already ex
penencing substantial psychological difficulty e a^ usefu j for

operated in a reasonably large number o sc oo s variables

generating hypotheses about which .—onaf ^ £ optl
may determine whether a program of t yp
mally utilized

PROGRAMS AIMED AT CURRICULUM IMPROVEMENT

The programs just described suggest^that^mtfflv^ ^ achieving primary

school as a total system may P as ust how much impact

prevention Doubts must remain k> ^ hoW wl dely such efforts can
these interventions may have an a , tota l school approach is

be implemented One of the pro e ^ professional or preprofes

that it generally requires the e * te ^ urce i imlt ations it is doubtful that
sional workers given manpow previously described For this

most schools could be served in the w y ^ effort$ on an ap-

reason among others some wor ^ i manpower to implement

proach that might require less ^jjwhools might adopt as a means
the strategy of developing cu dents The curriculum approac

of promoting the mental health of students

158 / primary prevention in the schools

mental health o£ the child may have been fostered by helping a teacher
work through feelings that might have led her to be destructive toward
the student. In general, by helping the teacher to handle difficult situa-
tions, the consultants may have permitted him to have more positive im-
pact on his students generally.

A project reported by Morse (1967) resembles the New Haven pro-
gram to the degree that the consultation model was employed and teach-
ers were the primary consultees. The Morse project placed greater em-
phasis, however, only on goals of true primary prevention. The present
effort, as with the New Haven project, began with careful steps to gain
entry to the schools, in this instance, elementary and junior high schools
located in Michigan. The project workers went so far as to create a "hos-
pitality index” to assess the degree of resistance to the intervention.
Based on this index, schools falling at different points along the hospitali-
ty dimension were selected as the target institutions. The consultants en-
tered each school prepared to offer whatever services were initially de-
sired. From this starting point, formulated to respect the idiosyncracies of
each institution, the project consultants worked to evolve an increasingly
comprehensive helping role for themselves. In many instances the serv-
ices of the consultant involved direct service to children with a secondary
preventive emphasis. The Michigan project also included, however, serv-
ices to teachers having primary prevention as their objective. These serv-
ices included didactic presentations on topics like personality theory;
more uniquely, the services included group sessions, for self-selected
teachers, that approached the character of group therapy.

The goals of group meetings included such things as enhancing the
self-esteem of the teachers so as to enable them to become more confi-
ent an irect in their classroom interactions. Assessment data, based
on self-perception inventories administered to teachers, was found to
s ow that participants in the group programs gained in their sense of
competence as had been hoped. Newer teachers were found to be partic-
ularly affected by the experience. In addition, children in the classes
filled out questionnaires on the perceptions of their classrooms. Here, the
data were generally positive, but less dearly so than the data on the
teachers themselves.

The final project we describe in this section is chosen primarily for the
uniqueness of its consultant team. This effort, involving schools in two
Texas school districts, is described by Iscoe, Pierce-Jones, Friedman, and
McGehearty (1967) . The consultants in this project were school psy-
chology graduate students who, as part of their training, acted as "child
behavior consultants" for half a day once a week in 14 diverse schools.
The student consultants, whose previous training had included psycho-
therapy experience, were prepared for their new role through orientation to

PROGRAMS AIMED AT CURRICULUM IMPROVEMENT / 161

for some children shoeing signs of disturbance Given the program goals,
a real test of the efficacy of the Bullis curriculum would require a longitu
dinal study following children who had experienced the program into
adulthood to determine whether their coping ability had been strength
ened Research of this hind has not been done, and one study casts doubt
on even the short range value of the Bullis approach

Leton (1957) compared the efFects of four different mental hygiene
programs on ninth graders who had scored poorly on an adjustment in
ventor) The four treatments were the Bulbs human relations course, a
series of mental h>giene movies, sociodrama and role playing, and a hob
by and crafts activity group Each experimental treatment group was
matched with a sample of diddren receiving no special attention The
basic framework of the experiment is shown in Table 1 As may be seen,
the experiment was done twice in two succeeding years with different
samples of students Results of the Leton study faded to demonstrate that
any of the interventions were superior to no treatment as measured by
pencil and paper tests of adjustment, school grades or school attendance
In two respects, however, the Leton study may not be a fair test of t
Bullis program First, the Bullis curriculum was conceived as a primary
preventive^, the inclusion of only students who were already ’
ing problems may ' have excluded the ^p most l^y f ^ ^

of students already at the high school level nr^vention in the

A second curriculum centered approach to pn P b ck t0 t he
schools was developed by Ojemann and his assoaa.es Da ^ g ^

research has been

Table 1

Framework of the Leton Experiment (Leton 1957 p 527)_

Ninth Grade Second Semester

Method

G d

N,

School method

Grade

N'

N

N t

N,

N

1 Activity

2 Bullis

3 Sociodrama

236

254

110

447

48

52

26

113

13

13

13

13

13

13

13

13

Sociodrama

Movies

Activity

Bullis

231

259

128

322

45

43

24

72

13

12

13

13

10 b

13

- — .. Mass N is the number of

•Grade A’ is the number and «, is hie comm,

students with deviant scores At, i _~, Iim em

sample , dropped out of school before dm expenmen

b Two students from this control group ppr
was completed

160 / primary prevention in the schools

addition to its possible efficiency is also attractive because it requires a
form of change within the school that is more familiar to educators and
potentially less threatening The programs to be discussed are based on
the assumption that children can be taught to understand themselves and
the psychological environment and that such learning will promote the
development of psychosocial adequacy These programs should not be
confused with projects to introduce a social sciences curriculum into the
schools (such as that proposed by Farris Kent, and Henderson, 1970)
where the goal is simply to introduce children to the fundamentals of an
important new science t

The Bullis (Bullis and O Malley, 1947) curriculum for classes in hu
man relations is a pioneer preventive program intended for children in
the late elementary or early secondary grades Starting in 1941 Bulbs
and his colleagues began to develop a fairly well specified sequence of
lesson plans for a course to augment the usual range of class activities
The program goal was clearly stated in the past our schools have put
all the emphasis on developing children intellectually and physically We
want them to grow up with robust personalities able to go through life m
an even keel (Bulbs and O Malley, 1947, pp 1-2) The specifically
preventive nature of the project is underscored by the fact that statistics
on psychiatric hospitalization psychological disability, and antisocial be
havior are presented as compelling reasons for instituting the human rela
tions courses

The Bulbs curriculum places heavy emphasis on active student partici
pation The teacher s role is primarily to introduce evocative material and
to facilitate class discussion Many of the lesson plans include short sto-
ries which the teacher reads to introduce topics such as the arousal of
emotions or the means for handlra.^ d&feA Tbs. twri vr-ViVcm, p’rw.'ies.
briefing for the teacher regarding the major psychological issues toward
which each lesson is directed Teachers who implement the program are
not assumed to begin with any particular sophistication in psychology or
the technique of group discussion leadership
The relatively limited demands made on the teacher and the minimal
time requirements of the course (one class per week) certainly make the
Bulbs program an easy one to implement Even so Bulbs and O Malley
are forced to note that adding a single class in human relations cannot in
itself have much impact and that greater degrees of effort on the part of
teachers and administrators may be required to create a meaningful pro-
gram Thus even the Bulbs curriculum may fail or succeed as a function
of total school situation

Evidence on the effectiveness of the Bulbs curriculum is sparse The
originators offer only anecdotal data indicating that the program was well
accepted by the children and played an early secondarily preventive role

PROGRAMS AIMED AT CURRICULUM IMPROVEMENT / 163

structors. Children in experimental and control classes were matched on
IQ, while teachers were matched on age, sex, experience, and education.
Prepost measures on a test of causal orientation, the Problem Situations
Test (PST) , showed the children in the experimental classes to have be-
come significantly more causally oriented than students in the control
classes. The data from this test is shown in Table 2, with a low PST score
indicating a more causal orientation. Recognizing that this difference
might be attributed to initial differences between teachers who entered
the program and those who did not, Ojemann used a self-control design
(that is, a comparison of an individual with himself) to show that two of
the teachers were significantly better at instilling a causal approach after
having been through program training than they had been before they

were trained.

The demonstration that Ojemann’s program leads to better causality
scores does not indicate that it enhances mental health. Several studies,
however, have attempted to relate the causal curriculum to various index-
es of psychological status. Levitt (1955) examined the effects of the pro-
gram on authoritarianism and responsibility in elementary school children
Three classes, a fourth, fifth, and sixth grade, were taught by teac •
ers svho had been trained in the causal approach. Two miuched contro
classes whose teachers had not been so trained were se,ccled f ° r ea “
perimental class. Posttest comparisons showed the ex ^"“ 1 ™ S ^ t ^, e( . n

be less authoritarian than the controls wid. .no

groups on the responsibility measure. It shou e no , ' j, ave

pretesting was done, and the differences in a * uthon “” ^

been due to initial unrecognized variations between *e

Bruce (1958) conduced a study o de, — ^^^djuit-
mann program on three variables ^ sixth-grade

mem: anxiety, security, and seH-.deahself-d.screpancy^ ^ ^ ^ *
classes were exposed to trained teac ' J variables were se-

period of 2 years. Control classes matched on

Table 2.

Mean Pretest and Pos.test Scores on the PST (Ojemann.

162 / primary prevention in the schools

done on the Ojeraann approach over the years, a fact that may be partial-
ly attributable to the nature of the program goals. Unlike the projects al-
ready described, the Iowa program has fairly definite objectives that are
more easily operationalized than such broad, vague goals as improved
adjustment or better self-image.

The focus of the Iowa intervention has been on the way in which chil-
dren learn to perceive and interpret human behavior. Ojemann (1960)
distinguishes between a causal approach, in which behavior is viewed as
having antecedents that must be considered before action is taken, and
the noncausal or punitive orientation where reasons and motives are dis-
regarded. Ojemann argues that the punitive approach leads to dissatisfy-
ing human relationships and that such relationships often lead to mental
illness. His observation of typical schools led Ojemann to conclude that
children were being trained toward a noncausal orientation. Teachers

were seen to model the punitive approach when they punished students
for misbehavior without questioning the reasons for the transgression.
School textbooks were also found to be faulty in their emphasis on the
facts of human events without examination of the motivations that
shaped those occurrences.

Ojemann s operational strategy involved modifying the existing school
curriculum to make it more relevant to issues of human behavior (Roen,
1967) . The means for implementing curriculum change has been the
training of teachers and the creation of new teaching materials in various
subject areas. In addition, the program includes consultation with the
trained teachers throughout the school year (Ojemann, Levitt, Lyle, and
Whiteside, 1955) .

A typical procedure for training teachers to give children a causal ori-
entation (Ojemann et al., 1955) begins with the selection of teachers
t rough consultation with school officials. The teachers chosen, undoubt-
e y a superior group, receive one month of triweekly training sessions
during the summer vacation period. Training is focused on the study of
normative developmental problems, indoctrination in the causal ap-
proach, discussion of techniques for dealing with classroom problems,
and the preparation or modification of teaching materials. In addition,
teachers recetve about 20 hours of group therapy over the summer. Be-
yond the summer program, teachers engage in trimonthly consultations
with project personnel to discuss materials, specific pupils, program eval-
uation, and further issues in child development. The variegated nature of
the teacher training makes it difficult, of course, to specify what elements
of the procedure are influential in producing any observed results

In a study of how effectively the program influenced the causal orien-
tation of children, Ojemann (1960) compared four elementary school
classes taught by trained teachers with four classes led by untrained in-

PROGRAMS TO MODIFY TEACHINC TECHNIQUES / 1 63

the goal of Roen’s program is simply to introduce another area of science
into the schools Roen also argues however, that the behavioral saences
curriculum could serve as a tool for early prevention The psychological
benefits of the program are said to derive from the ego-enhancing effect
of acquiring a new type of knowledge and from the increased comfort in
the school setting that the child might gain by studying the various influ
ences inv olv ed m the learning process

The behavioral saences curriculum has been tested m Massachusetts
fourth grade classes and in a residential treatment center for children
The time demands of the program seem quite modest, tilth one school al
lotting 45 minutes per tieek to the nett course of study

While data on the didactic success of the course is shown by Roen to
be impress it e, the et.dence on the mental health benehts of the program
is slight Roen cites an unpublished stud) done in 196a by Banolo
Spano designed to test the psychological impact of the behavioral sa
ences program The children taking the nets course tsere students m two
fourth grade classrooms of differing soaoeconomic composition .Two
control classes tsere matched on the basis of the economic background
tanable, IQ, age, and achietement level Spano employed =
psychological adjustment and personality onentauon it '
fees of weekly 50 minute classes conducted oser a fit e month penod
Findings shotted the experimental group 1 ^avuTon a nan

trols on measures of causal thinking an found to differ

ber of other instruments, however, the groups w

significantly .r „ ran be shown to be effec

The special virtue of Roen s program, , mD lemented The tech

live, is the relative ease with which it can learned m a single

mques needed to employ the nets cu! 7 iculu “ , bKn ^ doped. The
college seminar, one such ^ na ^ r ^ culum 1S mtnunal. and teaching
school time required to teach the „ roC mm

aides can assist the teacher in enlivening th p „

PROGRAMS TO MODIFY TEACHING TECHNIQUES ^ ^

The programs that follow rcptesent T , ]CSC programs

pects of the way in which teachers cerning the validity ol teach

are not founded on a stated plulosophy concernm^ ^ pr0g r3ms ,n d„s
ing goals or the value of “^ mqu e, to achieve whatever ends

section seek to provide teachers proponents assert) on the

they seek. These techmques arc founds jtheija ,*ha ,v,or

application of psychologv 35 f* 1 , xhe techniques involved often have
ank the laws by which it ,s modified. The

164 / primary prevention m the schools

Iected, and posttest comparisons were run that found the experimental
group to have lower anxiety scores and higher security scores Self ideal
self discrepancy did not differ significantly between the groups In a
more detailed study. Muss (1960) used six mental health scales and four
tests of causal orientation Subjects were members of three sixth grade
classes, one of which received 1 year under the program, one 2 years,
and the third no time m the program The group that received only I
year of treatment was not found to be superior to the no treatment con
trols The group that received 2 years in the program was more causally
oriented than the controls and also did better on three of the scales re
fleeting mental health (they were less authoritarian, more tolerant of am
biguity, and more aware of the probabalistic nature of events)

The data supportive of the Iowa approach are impressive, but two cau
tions are in order First, most of the instruments used to assess program
effects were paper and pencil tests and the children in the experimental
classes may have been inadvertantly influenced by the trained teacher to
recognize the socially desireable nature of the “healthy” response In the
a sence of observational data, it is impossible to say that the children in
t e experimental groups actually behaved differently in any way other
than test taking behavior Second the intervention involved a variety of
proce ures with teachers, and it is not clear that the causal curriculum
onentauon was the most potent factor producing the changes It is con
* e \ °* exam P le * that the group therapy experienced by the teachers
thJTw ' heir ° Utl00k suffiaen,1 >' to their psychological impact on
only dnf re i^ a m ° r r P< T Ve ° ne irres P e “*''« °£ the curriculum used The
which shnw ar ,n 8 d ‘ reCtly on th,s ,ssue is that of Ojemann et al (1955),
teachers did Program teaching materials employed by untrained

rhe matenal, Th n “ m ° re effe “- ^an controls without
ulum itself s ^ _^ emann s own wor k suggests that the formal cumc
mains in doubt° ™ aem ‘ 0 produce an effect - bu t what precisely is re

considerable *nrart e ? Ctm: dementS “ the Iowa ‘™nmg program » ° f
promm Wnothad ‘ mp ° m " ce As Roen C 1967 ) haf observed, the
program has not had widespread impact because the training Drocedure is
difficult to master and the structure of the ? S Procedure

curriculum structures in schools o ed, cation f^thT n<>t “““of
teacher training is to have greater b

necessan- to pare the training procedure to its essential elements
The final program discussed ,n this section constitutes a more narrowly
delineated curriculum modification than ,s exemplified by the Bulbs or

na.Tum n for P th r ° a ! : ROe " pTO P° Ses a behavioral sciences cur

riculum for the elementary schools which structurally resembles the kind

of course outline that might be used to teach any subject Indeed part of

PROGRAMS TO MODIFY TEACHING TECHNIQUES / 167

the research design was the frequency with which the teacher responded
to the child s appropriate behavior with approval and to inappropriate
behavior with disapproval The independent variable was manipulated by
instructing the teacher to withhold approval for a period of days and to
give frequent disapproval on other days, periods of baseline behavior
(approval predominant) were interspersed between the manipulated con
ditions The independent variable was the frequency with which disrup
tive behaviors, recorded by classroom observers using a time sampling
procedure, occurred during each of the experimental periods

Findings of the study showed that when the teacher stopped giving ap-
proval, the frequency of problem behaviors returned almost to baseline
level The frequency of disruptive behavior reached a peak during the pe
riod in which the teacher gave no approval for positive acts but much dis
approval for negative behavior The implications of these results are clear
for the teacher whose objective is to encourage task orientation and pro-
social behavior in the classroom Contingent positive reinforcement in the
form of teacher approval reduces or keeps low the frequency with w ic
children will engage in behaviors that frustrate the teacher s goals

An important point to observe in the study by Thomas and his asso-
ciates is the fact that the researchers actually instituted situations in the
classroom that they had reason to believe would produce negative | effeds
To demonstrate that teacher approval is crucial to ™ alntain, S
of disruptive behavior, the authors had the teacher deny all approval over
a period of days By instituting the ineffective condt.,on (Iow apP-val
for positive behavior) and returning later to a more d«rabk ^ond ton.
it was convincingly demonstrated that the rate of teacher appro™!
ly 'controlled theme of disruptive behavior Such »

tion technique could hardly be employe wl ^^any researcher would
the Iowa causal curriculum, it is very un ^ demonstrate that

institute a noncausal, pumtively onente pr gr (hc ncpmvc

subsequent exposure to the causal cumcu , jfian the oserall

effects The behavior.st, by playing 'Xtthm lors. ga.ns a free-
mental health of the child, that is. spe ((> t | ]e traditional inter

dom to manipulate conditions t nt is una ^ ([nt lhc behasionst

ventiomst Conceivably, the o[ hl5 .ntcnention, the greater the

can produce to substantiate the value of I ms in

likelihood of his selling his ideas in t e tsc 1 intervention in the class
Another example of behavioristicexpenmentaMn^^^^^ comrol
room is Packards 097 0 ) using ,n kindergarten

student attention The subje dependent \anablc was the per

and the third, fifth, and sixt 1 gra e im | ica mc of "pa)ing at

centage of time spent by stut BO ri_ The principle, expenmen

tention* to the teacher and the assigi

166 / primary prevention in the schools

their foundation in studies of animal behavior, particularly in studies of
operant conditioning.

The movement into the area of intervention grounded in learning theo-
ry requires a shift in perspective if the goals of the investigators are to be
understood. Ulrich, Stachnik, and Mabry (1970) speak explicitly of the
behaviorist becoming involved in the business of prevention, but they do
not speak of the prevention of mental illness as such. Rather, they see the
behaviorist as designing programs that will prevent relatively circum-
scribed, readily specifiable problem behaviors. That these behaviors may
be designated as mental illness by other psychologists is of no particular
interest to the committed behaviorist, because he' assumes that all behav-
iors (except, perhaps, those produced by bodily dysfunction) develop

om, are maintained by, and can be modified through the usual princi-
ples that govern behavior.

Although behavioristic interventive approaches rest on a philosophy
w tc differs from that of the projects discussed previously several simi-
lanties exist between the varied approaches. A broad similarity is that all
°. tee avioristic programs to be discussed share the primary preven-
tive orientation toward making the school a positive influence in chil-
, ” S . lve *' '”!?■ Stadmik, and Mabry express this positive approach
skills ,!!hLt ' aL ,° l j e . eXtent that a y° un gster acquires and engages in
in nrnhi . ' ar ° va } u ^ d *? y our culture ’ tllere is a concommitant decrease
proaches are C . a .™ r ^P' • A ' ! ° tJle behavioristically oriented ap-

approaches co'"" ” l ° * hC m ? re h ™ ani5tic efforts in that the differing
standing th th B L“ certa ‘ n critical points, for example, the under-
pin th h ", ShOUW bC * hen an °P timal *ance P m experience
iten be ilT ? Ung ; I ? d “ d - orthodox behavior ^differs
nesl Madden'r Zvi ^ the ‘ r g ° ak in £airly humanistic terms. Wit-
rouidr„pfa 7 lst“" IT "■ • • who habitually

esteem” and that "p n e un ^appy, unpopular, and low in self-

pti o Y rbeharii abLd

oriented programs cited earU^ Tiha"^ humanisticalIy

shaping behavior through , hk «*.

contingencies, obviously would find little virt P - CC1 * ely re gulated set of
jecfs emphasis on minimizing the "i, 2 Zt" '
child so as to release his creatfve ene^re” "" aCUv£ty ° f ' he

schio^esfatriniiefficTofmi * T” 7

proval on ordinary children. The -1^^^'
seven, in a group regarded as a "good.' class. The independent variable in

ALTERNATIVE SCHOOLS / 169

may not find truly effective reinforcers promptly, and may prematurely
conclude that the approach does not work Another reason for failure cit
ed by Abidin is the tendency for the mental health worker to oversell his
ideas to a degree that he seems to be denigrating traditional teaching
skills, thereby alienating the teachers whom he wishes to accept his
suggestions

Chandler (1970) describes an actual school consultation program de
signed to train teachers to use behavior modification techniques In dis
cussing this program, she emphasizes how the nature of the school as a
social system must be considered m the attempt to implement programs
For example, she notes that the psychologist is a potentially threatening
outsider in the school who cannot expect success if he overwhelms educi
tors with his own jargon or fails to recognize that his goals and those of
school personnel may not be identical Furthermore, C an er argues
that just as reinforcement may be the key to changing t e c i reus e
havior, it may also be necessary to reinforce appropriate behaviors on the
part of the school workers themselves if changes are to occur and persist
In a sense. Chandlers approach represents a synt esis wee " . ,

ntques of the behavtor modtfier and the systems analysts approach of
people like Kelly Thts type of synthes, s may offer pro m.« for e .abl»h
tng primary prevents programs that are both demonstrably effect, te
and capable of large scale implementation

ALTERNATIVE SCHOOLS

to mention an action strategy for

In closing this chapter, it ,s approp 5choo ] experience nh.ch

bringing children a psychologica y p n . The effort here is

evad?s the dtffict, lt.es of entering beheted to

to create new schools tha, tmmed.ate ly embody ^ di|Tcrcn ,

be desirable Projects to create “ “ '/ pub l,c faaltty have been spurred
environment than is found m the yp P mcrh , n School) , Montcssor.
on by the work of educators like ( ^ wor kers and others Invc

and Dennison The innovative progra j^fost of the schools founded

been increasingly imitated in recent yrn ** ^ setting that cn

recently seem to represent an eltor I loosens the structures tint
courages cooperation over competition ‘ , to j\reen (1973) the

constrain the child s choice of actiw ) . QUt 23 in the late 1960s to
number of these schools has grown ro recent legal challenges to

: present Atccnarpms mcr tax re

are than 600 at present Arcen argil mon0 pol> over tax i

the public education'll establishment^ ^ « that innovative schools will

tne public eaucauun ** , r M ,

enue for education raise distinct P° SS1 sl ,pport and will at least par
eventually begin to receive more public suj pu

168 / primary prevention in the schools

, >.« m baseline (21 instructions to attend unaccom

panied by'oAer^reinforcements and (B) a spec,al group co„u„ge =
Len m wh.ch the teacher gave tokens or pnv, leges to all the ch.ldren
when criterion levels of class were showing attentive behavior An
server was also present to record attentional behavior of specific children
in the group Although the actual experimental conditions were ^ y
complef and variations existed between the precise methods used at dlf
ferent grade levels the basic findings are readily communicable The
group contingent reinforcement was found to be effective at all grade le
els in increasing the percentage of time spent attending When reinforce
ment was discontinued attention dropped when reinforcement was
reinstated attention levels rose again The instructions only condition
produced attention levels above baseline for some classes but where it oc
curred the increase was less dramatic than that shown with the reinforce
ment Packard noted the encouraging fact that the teachers were able to
measure the occurrence of the target behavior and did not need the e p

of an outside observer to know when to give reinforcements

One might well ask at this point whether a school intervention to dem
onstrate ways of reducing disruptive behavior or increasing classroom at
tention is really relevant to the prevention of psychological disturbance
Chandler (1971) offers two affirmative lines of reasoning She suggests
that when a child performs poorly in school he is likely to receive nega
tive labels such as lazy or immature This outcome in itself could
have detrimental effects on the child s self esteem and relations with oth

ers Yet if appropriate classroom management techniques can increase
the probability that a given child will perform within accepted norms the
risk that negative labels will be applied is reduced Furthermore the be
havioristic intervention may enhance the future well being of the child by
increasing his chances of acquiring the skills he will find useful in later
life To the extent that academic and vocational success are relevant to
adjustment any intervention that enables the child to acquire the skills
for such success will positively affect future psychological adequacy

The two projects described as examples of contingency management in
the classroom are actually experimental studies rather than organized
prevention programs The issue remains as to whether the approach lllus
trated by these studies can be implemented on a wide scale We have al
ready mentioned that the behavioristic approach has the advantage of
yielding concrete evidence of effectiveness which may sell the program to
school personnel It may not be enough however for the psychologist to
produce graphs and tables to show that a technique has proved useful m
an experimental study Abidin (1971) notes that attempts made by
school psychologists to implement behavior modification programs often
fail for one or more of several reasons One reason is that the teacher

REFERENCES / 171

Bower, E M Primary prevention m a school setting In G Caplan (Ed ) , Preven
txon of mental disorders in children New York Basic Books, 1961 Pp 353-
377

Bower, E M , & Hollister, W G (Eds ) Behavioral science frontiers in education
New York Wiley, 1967

Bruce, P Relationship of self acceptance to other variables with sixth grade
children oriented m self understanding Journal of Educational Psychology,
1958, 49, 229-238

Bullis, H E , & O Malley, E E Human relations in the classroom Wilmington,
Del Hambleton, 1947

Caplan, G Prevention of mental disorders in children New York Basic Books,

1301

Carroll, J F X , Bell, A A , Minor, M W , & Brecher, H An ecological analysis
of and prescription for student dissent In W L Cla.bom and R Cohen
(Eds ) , School intervention New York Behavioral Publications, 1973 Pp

110-121 , ,
Carter, J W Research contributions from psychology to commune ,y mental
health New York Behavioral Publications, 1968
Chandler, G E Proving training in behavior modification for school percon
Paper presented a, the = ^

Symposium in Community Clinical Psycno gy .

Cowen, E L , Gardner, E A , Zax. M Emergen, approaches ,0 mental health
problems New York Appleton Century Croft, 19
Davis, J A Education for positive menial health Chicago A1

n. A model for change within Paper

DeCh p rn,ed in

Community Cf.n.caf Psychology -nee » -

Fams, H E.Kent.N D , & Henderson. ^ llR UlnchT Stachmk, 1 J Mabry
elementary and junior high senoo Glenview, 111 Scott Foresman

(Eds ) , Control of human behavior ( o )

and Co , 1970 Pp 309-314 McGehMrt y. L Some s.ra.cgies in

Iscoe, I , Pierce Jones, J , Friedman, > ^ ^ Gardner, &. M Zax (E<U),

mental health consultation In ^ , Problems New York Appleton Ccn

Emergen, approaches to mental health problems

tury Crofts, 1967 Pp 307-330 confirmation An sample

Kelly, J G Naturalistic obsenaMons

Human Development, 1967, , “ nt »e intervention* In J

Kelly, J G Toward an ecological co "^ , ‘® n °i jn psychology to community
V Carter (Ed), Research -"'“'iuon, .963 Pp **•»
mental health New York B iav me „ uI hygiene Mental

Leton. D A An evaluation of group methods
Hygiene, 1957, 4L 525-533

170 / primary prevention tn the schools

ually supplant the state tun institutions Whether or not this happens
clearly the movement toward alternative schools is significant enough to
provide a counterpoint in a chapter heavily laden with discussions of the
difficulty involved in changing existing institutions

CONCLUSION

The goal of establishing primary prevention programs in existing schools
is difficult to achieve but is worthwhile to pursue The two challenges
facing the interventionist are the need to demonstrate that his efforts will
have substantial positive effects and the need to implement his approach
by gaming entry into an institutional setting where workers may fear or
discount his efforts Although several of the programs described m this
chapter offer evidence of positive effect none has been widely sought or
accepted within the educational community Successful future efforts
may depend on an increased sophistication in the techniques of analyzing
the social system of the school and of designing preventive interventions
that fit the needs and tolerances of school personnel In a larger sense
the success of efforts to improve the psychological environment of the
schools may depend on an understanding of the entire community as it
functions to maintain or alter its institutional subsystems like the schools
Conceivably alternate schools may ultimately supplant some of the exist
ing facilities thereby sidestepping some of the problems of providing
children with new types of learning environments Barring this possibility
however the community worker will continue to be confronted with the
multifaceted task of proving that he can design school environments that
truly foster psychological development and then of finding a way to ac
tualize his principles

References

Abidin R R What s wrong with behavior modification Journal of School
Psychology 1971 9 38-42

Areen J C Alternative schools Better guardians than family or state? School
Review 1973 81 175-193

Biber B Integration of mental health principles in the school setting In G
Caplan (Ed ) Prevention of mental disorders tn children New York Basic
Books 1961 Pp 323-352

Biber B A learning teaching paradigm for integrating intellectual and affective
processes In E Bower and W G Hollister (Eds) Behavioral science
frontiers in education New York Wiley 1967

4

7 . secondary prevention in the schools

, chapters either involve pn
The school programs described *" P”j“ he [earning conditions for all
mary prevention (attempts to op fprtiar v preventive efforts In this
children) , new types of treatment, or ^ ,dentify as early as pos

chapter we emphasize programs t la maladjustment or more sort

sible the child who is likely to sufTe s of the disorder Seseral

ous disturbances, and (b) to prese focusing, for the most part,

programs of this kind base appeare Both components of sccon arj

on children in the earliest schoo! , 5 entl0 n) arc not al« a) s present in

prevention (early identification and proven
these programs, as vve shall learn

THE ST. LOUIS PROJECT „ e programs was or.g,

One of the pioneering .school secon^ JponJore d li» an orgamra

nated in St. Louis in 191/ us 1,3

172 / primary prevention in the schools

Levitt, E E The effect of a "causal” teacher training program on authoritiamsm
and responsibility in grade school children Psychological Reports, 1955, 1,
449-458

Madden, P C Skinner and the open classroom School Review, 1972, 81, 100-107
Minor, M Systems analysis and school psychology Journal of School Psychology,
1972, 10, 227-232

Minuchin, P, Biber, B, Shapiro, E, & Zimiles, H The psychological tmpact of
the school experience New York Basic Books, 1969
Morse, W C Enhancing the classroom teacher’s mental health function In E L
Cowen, E A Gardner, & M Zax (Eds), Emergent approaches to mental
health problems New York Appleton Century Crofts, 1967 Pp 271-289
Mosher, R L , & Spnnthall, N A Psychological education in secondary schools
A program to promote individual and human development American
Psychologist, 1970, 25, 91 1-924

Muss, R E The effects of a one and two year causal learning program Journal of
Personality, 1960, 28, 479-491

Ojemann, R H Sources of infection revealed in preventive psychiatry research
American Journal of Public Health, 1960, 50, 329-335
Ojemann, R H Levitt, E E , Lyle, W H , & Whiteside, M F The effects of a
‘ causal teacher training program and certain curricular changes on grade
school children Journal of Experimental Education, 1955, 24, 95-114
Packard, R G The control of classroom attention A group contingency for
complex behavior Journal of Applied Behavior Analysis, 1970, 3, 13-28
Roen, S R Primary prevention in the classroom through a teaching program in
the behavioral sciences In E L Cowen, E A Gardner, & M Zax (Eds),
Emergent approaches to mental health problems New York Appleton Cen
tury Crofts, 1967 Pp 252-270

Sarason, S B , Levine, M , Goldenberg, I I , Cherlin, D L , & Bennett, E M
Psychology in community settings New York Wiley, 1966
Thomas, D R , Becker, W C , 8. Armstrong M Production and elimination of
disruptive classroom behavior by systematically varying teacher s behavior
Journal of Applied Behavior Analysis, 1968, 1, 34—45
Ulrich, R Stachnik, T, & Mabry, J Control of Human Behavior, Vol II ,
Glenview, 111 Scott Foresman, 1970

Zimiles, H Preventive aspects of school experience In E L Cowen, E A
Gardner, 8. M Zax (Eds), Emergent approaches to mental health problems
New York Appleton Century Crofts. 1967 Pp 239-251

THE ST LOUIS PROJECT / 175

two mental health services being offered in concert were the parent
group therapy program and the broad scale mental health education pro
gram

Although early evaluations of the effects of the St Louis program
were encouraging, a more rigorous evaluation seemed necessary (Gildea,
1959, Rae Grant and Stringer, 1969) The design of such an evaluation
required the development of instruments for assessing the adjustment of
the child and the attitudes of the mothers who were the prime target of
the preventive program (Ghdewell, Mensh, and Gildea, 1957) The ma
jor evaluation study was done across 15 schools, using 30 third grade
classrooms which were divided into experimental and control classes
total of 830 families were involved in the first year of the study T e con
siderable attrition that occurred by the conclusion of the study two and
one half years later reduced this figure by one half Two experimenta
conditions were evaluated the volunteer lay education program, anc
combination of the volunteer program plus the consu tatl °" ° a
health professional In addition, a no treatment contro cone i 1
up as a baseline for comparing the effectiveness of the two experimental

"szz&ssrz?—*

the last occurring two and one hall years after t e i „ rl] d t

struments used with the children included a
by the mother teachers’ ratings of the

indexes on which children evaluated each other, and semiprojectwe

Mothers attitudes were studied on a ,7 lteI "‘ l “ Over the three year

The results of this evaluation were cI ? e rs ratings mdica.

period during which the ctuldren i were m the experimental

ed that all children got worse and controls The experimen

groups seemed to worsen more mar y 01 nt It conceivably

ters regarded this finding as positive fromone, ^ more sen
indicated that teachers, as a result o P

sitive to emotional adjustment in chi en evaluate the children,

On the other hand mothers, w o were jj OW ever, no difference was
felt that the children improved be avI °™ control mothers in this re
found between the ratings of experirne experimental and control

spect Also, no differences were oun , reanne There was a small

mothers with respect to attitudes to " ar , ers * rep orts of symptoms and
positive correlation between change in n ^ ence between mothers

change in their attitudes, reflecting a ^ jammers’ impressions
impressions of improvements in t le c t |ns change was unrclat

of improvement m mothers attituc e _ xpcn enced Clearly, tlic oscra
ed to the type of mental health progr program are not encouraging
results of this evaluation of t ie t

174 f secondary prevention tn the schools

tion of educators and laymen called the St Louis Council for Parent Ed
ucation (Gildea, Glidewell, and Kantor, 1961, 1967) During its modest
beginning, this program was based m two schools in which teachers iden
tified certain problem children on the basis of their classroom behavior,
and invited the mothers of these children to participate m group therapy
(Buchmueller, and Gildea, 1949) Social workers assigned to the project
schools interviewed prospective group therapy participants to learn about
the family, to encourage ventilation of feelings (about the school, the
child, the teacher) , and to broach the idea of group therapy This empha
sis on intervention with the mothers of the problem school child has been
a hallmark of the St Louis program over the years Buchmueller and Gil
dea (1949) reported that 75 percent of the children whose mothers par
ticipated in the group therapy were judged by teachers to have improved
in their school behavior, whereas about 80 percent of comparable clnl
dren whose parents were not seen were judged to be unimproved Unfor-
tunately, the design of this study was such that teachers who acted as
judges were reporting their ratings to parent group leaders, and their
ego-involvement in the success of the program could have been a source
of bias

The apparent success of group therapy prompted a program expansion
to include several other schools, using a variety of workers as group lead
ers As the program broadened, it became apparent that the group thera
py approach was not uniformly successful In some schools, most notably
all black schools, the service was decisively rejected Project leaders hy
pothesized that the early success of the program probably resulted from
the fact that it dealt with middle class mothers who understood and ac
cepted mental health concepts The program failed in schools where par
ents seemed to have a poorer understanding of these concepts and were
not ready to accept their significance Therefore, it seemed necessary to
prepare the school and the parents to accept secondary preventive inter
\ention by instituting a broad mental health education program In some
respects this aspect of the St Louis program involved primary preven
tion as this was considered to be necessary to make possible a more in
tensive involvement with the parents of problem children
The broad gauge education program was carried out by a group of
volunteers who led group discussions, generally centering around ideas
provoked by mental health films These lay discussion leaders were
trained in workshops by professionals Little effort was made initially to
screen applicants for leader roles To a certain extent, volunteers selected
themselves in that many failed to complete training and others dropped
out after leading a few groups, since they felt poorly suited to such work
Discussion leaders worked in pairs at schools, PTA’s, mothers’ clubs,
churches, service clubs, and wherever else they were requested Thus the

T1ir.CAUTOVr.tA JTAT r. WVCATtOXAt. VTTAVT^F’n rVOCVAU f 177

THE CALIFORNIA STATE EDUCATIONAL DEPARTMENT
PROGRAM

Bower and his associates (Bower, I960; Bower and Lambert, J96J) did
an elaborate study in California on the early identification of emotional
disorders in school children. Although their work focused on only one
component of a secondary preventive program, it has provided means for
identifying emotional handicaps in youngsters in the early school grades
that have !>ecn used in other secondary preventive programs (c.g., t jc
R ochester Primary Mental Health program to be described later) .

Bower’s ambitious early identification, program was conducted in 7a
California school districts with screening data collected for approximately
5500 children, 207 of whom were identified as emotionally dis u , .
This designation was made by mental health workers ,n the sch dn.
tries from which the children were chosen. Worker, were asked to seta
a number of emotionally disturbed children representamc of the d^v
turbed children in their district. The purpose of . Z
mine the extent to which information available to r _ ; j j
mal course of instruction could be used to identify children recognised by
experienced clinicians as emotionally disturlied.

Teachers were asked to collect dataon ^ tta^ tSain
without knowledge of the study's P ur P ®*" . ]t ,listurf>cd. The follow-

of their pupils had bee "^*|"^ , be child’, chronological age, (2) the
»ng information was collected. (1) t c ^ (3) fever's occupa^

number of absence* in a four-montl P- arithmetic achievement,

tion, (4) standardized test scores in rca mg K jf. mra surc enti-

(5) a group 10. test s«zre. ^^HnaJomc.ric device en-
tied "Tliinking About Yourself , (7) , in „ on edi child's physi-

titlcd "A Class Play," and (8) the Jnd "Thinking About

cal and emotional characteristics. rtn nort unity 10 describe himwlf

Yourself" (TAY) the child was g.-i an mcl , lired the div

as he felt he was and as he woul . j n "The Class Play, each

crcpancy between the self- and > » ' t) , c vehicle of casting positive and
child was rated by his peers thr g Vr -as to put on. EaH»

negative roles for a hypothetic^ p a * , flections made for him

child's score was the percentage o n '*\ . a ]j y d^turbed children wit i
by his peers. Analyses compared t <- measures taken,

tfieir nondisturbed peers on each of ? j c) „1dren were older and
It was found that the ” but these differenem were

more frequently absent than their ,* t «en the groups on

not significant. While *« «“=£££ favoring the nondisturbed
socioeconomic status, signifies . tmetic achievement t«t scores (

group were found on reading and ar.thmet.

176 / secondary prevention in the schools

In its most recent phase the St Louis program has begun to empha
size v£ry early detection of potential for school problems and the devel
opment of programs for preventing such disturbance (Rae-Grant and
Stringer 1969) This program phase emerged after the recognition by a
senior school mental health worker that the practice of automatic or so
cial promotions for all children regardless of achievement was not work
ing out well School records clearly demonstrated that the achievement of
many children steadily worsened from year to year through the elementa
ry grades and that little was being done to deal with the problems
prompting this decline For this reason an instrument called the Academ
ic Progress Chart (APC) was developed (Stringer 1959) The APC is
an objective index of a child s academic progress as reflected m his scores
on standardized achievement tests generally used m schools and it can
provide a graphic picture of the contrasting results of social promotions
and retention in a grade The chart is a grid with chronological age on
the horizontal axis and grade level on the vertical A diagonal line plots
the grade level at which the achievement test is administered and a child s
median score on the test battery is also plotted relative to test grade level
Thus easy comparison can be made between a given child s actual prog
ress and the progress that he should be making (based on national
achievement test norms) Figure 1 provides examples of the APC s of
two different children

The APC was also recognized as a potential screening tool for detect
ing early school maladjustment A research study using this instrument
demonstrated that 61 percent of the cases eventually referred to school
mental health services could have been referred on the basis of their APC
anywhere from one to eight years earlier

Later when a sizeable group of mothers participating in research inter
views concerning their children were found to derive considerable per
sonal benefit the idea arose of conducting such interviews with every
mother whose child was entering school It was felt that the interview
could deal with already existing problems and might help to innoculate
the child against future problems This prompted development of a new
preventive program called Mothers As Colleagues in School Mental
Health Work Most recent informal evaluations of this program indicate
that it is working well and that it is promoting understanding between
school and mental health personnel

Associated with the preventive program focusing on mothers of enter
ing elementary students has been a trend for increased consultation with
teachers by school mental health workers This too has a generally pre
%enti\e impact through the education that it provides for teachers Future
programs of the St Louis group will undoubtedly expand m this direc
tion

TUT CALIFORNIA STATE EDUCATIONAL DEPARTMENT PROGRAM / 179

Academic progress chart

. . m£! a 0 4 lag second grade,

■uptive, and his 0 2 lead at first-gra e evo and the stepmother, warmly

a 0 8 lag a, th.rd grade Then ^ health counsellor and

:oncerned to help the boy, sought and in developing a

made good gains in learning to on ers | |fn j ts to his acting-out In the

positive relationship with him, even w i f rom below the normal line to

next year he made a remarkable gam, m 8 ^ ^ fhg fo „ ow | ng year this
above it, lumping 2 6 grade leve s in on . $|f y an d aggressiveness were

gain was further increased Meanwhi e ^ , he 5lxt h grade he was a

subsiding toward normal levels, and a respects a leader (Stringer,

well-accepted member of h,s class, and in sam

7 —

Examples of APCs of twaddle™

178 / secondary prevention in the schools

Academic progress chart

■ L SIV f" COpyi " a Work of his classmate. Since he was a recent transfer
to the school, no test data were available for his earlier years, but at sixth
grade he was lagging by 07 grades, and in seventh grade his lag increased
to 2.0 grades. The mental health counsellor had meanwhile talked with the

,h6 Ch " d Guid ° nre Clinic dta 9”° 5,!c
evaluation ofthe boy. Cl, nlc study, completed during the summer vacation, led to
an offer of chnlc treatment for the boy, and this was begun as the next school
term began By the end of that year (eighth grade) he had decreased his lag to

I. 5 grades, had clearly reversed his earlier downward trend, and seemed well
on the way to making up all of his earlier loss (Stringer, 1959 12-19).

II. A behavior problem, he was considered bright and had done well in his grade,
but then his mother died, and he was left to the care of elderly and over-
indulgent grandparents. He became obese and increasingly aggressive and dls-

HOW TO ANSWER THE QUESTION S IN THIS BOOKLET

This is an EXAMPLE of the questions you Fre K ,

... ... Always quenfly Seldom Never

will be asked to answer ' — - —

This boy is usually picked first to play on

a team m rn

1 Are you like him? ^000
2 Do you want to be like him? ^

In answering the first question "Are you place the X

any one of the four boxes If you feel you , a n X in Box 2 If on

in Bax 1 If you feel you are like this boy frequen y, p f feel

the other hand vou are like this boy seldom, place he X n Box 3 y

any one ot tne tour Doxes u , Y m Box 2 It on

in Box 1 If you feel you are like this boy frequen y, p f feel

the other hand you are like this boy seldom, p ace he X » te 3 y

you are never picked first to ploy on a team, ploee the X m Bo

. Unvo to think about what you want
In answering the second question, yo f or you if you would

to be and put an X in the box which wou ® x in Box 5 If you would

like to be someone who is picked first a ways, p 6 , f on t h e other hand you
like to be picked first frequently, place 1 ® 7 jf you don't care at all

would like to be this boy seldom, place «« ■* 1 '» J B
and would never like to be chosen first, pbce an

-t-e KpilrtW— —

Pre*

Alway^*!?!!!^

his boy likes to do daring things j=r rj □ LJ

1 Are you like him? LJ Q p

2 Do you want to be like him^

his boy worries about tests _ rn Q D 3

1 Are you like him? U g □

2 Do you want to be Ite to?

'if you st,iilS^^^ W '°°Tand Your teacher will give y« *•
Mso, if you need help later on, raise y

lelp you need __

Now turn the page and be gin ____ -r-^^TSlducation

o* Education, Sacramento

Published by the California ,957

Now try to complete the two examples ^

rr^-> Bo " er xm

Instructions for

180 / secondary prevention in the schools

the fourth-, fifth-, and sixth grade levels) and on group intelligence tests
However, intellectual differences were not found when IQ was measured
by individually administered tests. Bower explained this discrepancy by
pointing out that the group test emphasizes school-related material more
than the individual intelligence test. Self-perception scores, as measured
by the TAY, indicated that emotionally handicapped children are more
dissatisfied with themselves, showing a greater discrepancy between self-

A CLASS PLAY

Prepared by Eli M Bower and Carl A. Larson
California State Department of Education

SECTION I

Just suppose your class was going to put on a play and you are selected as
the director When you turn the page you will find a list of some of the parts
in this play As director of the play, you have to pick a boy or girl in your class
for each of the parts In order to make your play a successful one and a lot of
fun, you will need to pick a boy or girl who you think would be best able to play
the part Since many of the parts listed are small ones, you may, if you wish,
select the same boy or girl for more than one part Do not choose yourself for
any of the parts You will have a chance to do this later.

Make your choices carefully and if you have any questions about the meaning
of a word or anything else be sure to ask your teacher

Copyright, 1957, by the California State Department of Education
Published by the California State Department of Education, Sacramento, 1957

THINKING ABOUT YOURSELF
Prepared by Carl A Larson and El. M Bower
California State Department of Education, Sacramento

Form A
For Boys

The questions In this booklet will make you think about yourself Because ail of
you like different things, each of you will probably answer the questions differ-
ently What you say will help us to find out what boys like you are thinking and
wishing Do your best to make your answer to each question tell what you really
think and really wish

THE PACE I. n. CENTER PROJECT / 183

Five social workers served on the Pace staff and serviced approximately
30 children in each o£ the E schools. As soon as a project E child was
identified, teachers and other school personnel were notified. Typica y,
the Pace social worker was invited to the school to discuss the program
and to. get to know the teachers. Other essential aspects of the social
worker’s role were to develop a relationship with the principa , an
come acquainted with other key school personnel to maximize coo[
tion. An early problem in dealing with teachers and other school per on-
nel was to explain why some children were receiving speed fatten non
while others were not, and to fend off efforts to have the social worker
deal with children who were immediate problems for t e s

" 25 , - rrfXZXZS.

principals of all developments „ have close contact with

and parents. Social workers were also r <1 depending on the indi-
teachers through formal or informal' 3 ^ 0 ™^ while others

vidual teacher’s style. Thus some meet g „ in 5C hool corridors

were held over coffee, at lunchtime, an o Finally, within the

as people were moving from one place to another^ ^ ^ ^

school, the social worker directly o sen. acquainted with his

room and in other school situations to ec ^ combination of these

behavior and reactions to stressful situation i 10 rae background

observations plus knowledge concerning help teachers under-

frequently made it possible for the social worker P

stand a child's behavior. ornuainted with the Pacer and

Once the worker had become we j-e contact with the chi s

school personnel, it became essentia problem to the school, there

family. In cases where the child was an over ^ ^ howeV er, in
was little difficulty in making sue - oUS problem by principa an

which the child was not viewe as . . t h e child’s parents. As a re
teacher, there was resistance to a PP observing the child unti an
suit, the worker was required to approach to families

portune time arose to intervene. The ^ ^ needs of the child, the

was highly flexible and was shaped [^“^lude of the parents. There was
needs of the school system, an t he time and place o m

also considerable flexibility concern S the home , but othe

with the family: some meetings took | P* ^ ^ ]ibrary , or a a bar.

held at places of employment ■" P ^ aU o£ the ■mP ort ’"!
Wherever possible a worker at e nment . in each case < ,e abrupt-
in the child’s immediate llonl al e int< . r< . s i and involvement . rstami t ], e

er attempted to secure paren 1 .fljbrium. To fuH> > d h - 3lI

ing what might be a delicate fann y acql ,a.ntcd

child’s problems, it was necessary

182 / secondary prevention in the schooh

and ideal image than their nonhandicapped peers Likewise the emotion
ally handicapped children were assigned negative roles on ‘The Class
Play’ significantly more often than the nonhandicapped Finally, teach
ers reports indicated a far bigger percentage of the emotionally handi
capped group displayed negative classroom behaviors than did their peers
who were not seen as handicapped

This study demonstrated that a variety of measures taken in the ordi
nary classroom can differentiate emotionally handicapped children from
nonhandicapped children This indicates that wide scale screening proce
dures can be done within the ordinary classroom that would identify, as
early as the fourth to sixth grades children who need help with emotional
problems

THE PACE I I) CENTER PROJECT

The Pace I D Center, an agency established with federal funds in the
Northern part of San Mateo County, California is also concerned with
the early identification and prevention of emotional disorders in school
children (Brownbndge and Van Vleet, 1969) The Pace program fo
cused on a population of approximately 6000 school children in the kin
dergarten through fourth grade in both the public and parochial system
of northern San Mateo County In this population, a sample of 354 were
identified as needing the preventive services of a social worker The pri
mary instrument used for identifying these children was the AML Behav
lor Rating Scale This instrument used by the teacher, is an 11 item
checklist having five aggression items (A) , five moodiness items (M) ,
and one learning disability item (L) Aggression items describe fighting
restlessness disruptiveness obstinacy, and impulsivity, moodiness items
decribe children who are unhappy, prone to becoming ill, sensitive to
criticism, in need of coaxing and are moody The teacher rates each item
on a five point scale ranging from seldom (1) to always (5) Four scores
are erived from this scale the aggression score, the moodiness score
the learning disability score and a total score The range of scores is
from 11 to 55 The children included in the Pace I D prevention study
were those scoring in the highest 10 percent of their prospective school

?nic 1CtS T AML SCale who W€re under 10 years of age as of July I.
1966, and whose families were not on the active roster of a social agency
at die time the child was screened The 354 children meeting these enter
n were assigned randomly to an experimental (E) or control (C) group
matched according to grade level sex, and the AML learning disability
score

The preventive program was earned out by the school social worker

THE ROCHESTER PRIMARY MENTAL HEALTH PROJECT / 185

Zax and Couen 1969) While the general objectives of this program
have been the early identification and prevention of emotional disorder in
school children a basic feature of this program s approach has been the
utilization of nonprofessional manpower in the schools
The impetus behind the development of the Rochester program stems
from two frequently made observations First teachers commonly recog
nize that a large percentage of their class time is taken up by the nee to
work with relatively few youngsters Second school mental hea t wor
ers often find that referrals increase markedly during the transition peno
from elementary to high school a time when resources for ea ing wi
serious problems are relatively meager Furthermore the sc oo rec°r *
of youngsters referred at this point in their academic career o ten
that many early signs of school maladjustment have een , S n ° re ,

seemed worthwhile to concentrate mental health services in ie ^

school grades in an effort to promote prompt 1 enti ca ion
impending disorder and to take preventive measures that might make

er referral unnecessary , , c _ ria i WO rker

In the early stage of the program a psychologist an ^ djsor

concerned with the early identification and prevention o Iementar y

tiers were asstgned full ..me to the pnmary * ° n ” as Z

school The experimental (E) school was » a

cioeconomically upper lower class and sras families

uve of the city at large except for the fac .h t bhc ^ J ^ fron)
were underrepresented Two demographical y coup m connec

contiguous neighborhoods were used as con ro

tion with the assessment of project outcome mion pj iase were two

The early identification phase an t e p ^ the ear j y jdentifica
clear cut components of the Rochester progr m sta ges The social

tion phase remaining stable through many to j e arn about the

worker interviewed the mothers of a rs « attitudes toward edu
child and his development family patterns t j ie family so that the

cation and to open a line of communicatio jf necessary Classroom
social worker might be used l ater * s a ^ qc hers reported on classroom
observations were made of all chi ren ^ one ^th the first gra ers

behavior and some psychological t « stl "S made concerning eac

On the basis of these data a clinical judgment w have great po-

child Those already manifesting P roW *™ cal i e d the Red Tag (RT)
tential for doing so in the future av to CO ntinue to o so

group Those doing well and thought Uke V percentages h

been called the Non Red Tag ^^^Tughly about 30
varied across groups and from year . * La ter research on
entering first ‘graders have been ^ f, *J ated that data unbred in
contributing to the RT designation

184 / secondary prevention in the schools

of problems that beset the family as a unit, because the child s difficulty
often stemmed from an overall adjustment problem suffered by the family
Another component of the Pace program involved the use of three
psychiatric consultants serving as collaborators with the social workers
engaged in the front line program operation The consultants, all grained
child psychiatrists, helped with understanding the dynamics of specific
cases and in setting up specific intervention plans In addition, they were
concerned with social workers’ style of interaction with the school system
and other relevant community agencies The consultant also helped With
the general problem of role definition for the social worker

Evaluation of the effects of the Pace program was based on essentially
four types of instruments (1) the AML Behavior Rating Scale, (2)
achievement test scores, (3) the Bender Visual Motor Gestalt Test, and
(4) the Draw A Person Test The AML was administered on five differ
ent occasions in the two years during which the project was conducted
Comparisons of E and C groups for change over that two-year period
demonstrated that there was a significant difference on the M subscale,
indicating that the E group was less moody after the treatment than the C
group Similar results were found with a subsample of E subjects who
had received particularly intensive attention from the social workers Sig
mficant differences were also found on the A subscale, as E subjects
showed a significantly greater pre post decrease m aggression than did C
subjects Although the E group gained significantly more than the C
group on the arithmetic achievement tests neither group achieved the ex
pected gain of one school year No significant differences were found be
tween the two groups on the Bender or on the Draw A Person Tests
Overall, these results reflect some significant E group improvement in the
Pace program

Qualitatively, the Pace staff was able to identify retrospectively several
factors that seemed to contribute to positive change m the children with
whom they worked These included a low case load allowing a flexible
and intensive effort with particular children, the individualization of pro
grams in line with the problems and needs of the child, consultative sup
port, and the coordination of school services with family and community
resources

THE ROCHESTER PRIMARY MENTAL HEALTH PROJECT

Like the St Louis project the Primary Mental Health Project of Roches
ter, New York is a program that has spanned several years and has
passed through several stages (Cowen, Izzo, Miles, Telschow, Trost, and
Zax, 1963, Cowen, Zax, Izzo, and Trost, 1966, Zax and Cowen, 1967,

Table 1 Comparisons of RT and NRT Groups Tested in 1961 and 1962 (from Zax and Cowen, 1969)

' L-) -• CO CJ — « NCJ if)’’

e/ ct ct

m o o in s“ o « s m l", o in " o w e

— O — fOOOOWM

nCi«iflh>inOOO MI'SSSSCm

Oilb6Snt'i»"-«r* 0 u-j 05 oo O r~ f

-ffl«-N030iMON ^ ^ ^ ^ ^

— > 61 ^ “ 0,1

“ © q Sj f} Sj | | |2J ~ ^ ^ 1 1

- -«N- ~ ^ ^ —

SSgggS I I IS “"“O®

! 2 S IrJ § Q

i i i ;

5S S K ^ i i I

® n ? ■

MIS SS?SS I 1 1

,-sjjgs, , ,8 88825 , | I

1 - ^ ^ ° 2 1 1 1 <* e-f«2

8 8

111 Hi

S £■». = ■?
•s| ; 5.5 j
t: _§ s w cu a

: C C |

! § s

i 1

,ssgg = ?SS

c> o
V V

186 / secondary prevention in the schools

the social worker’s interview contribute heavily to the judgment, and that
the overall quality of family life seems to be the most influential factor in
determining whether a youngster will be designated RT or NRT. Fur-
thermore, from this research it has been possible to develop a continuous
instead of a binary judgment concerning the potential for a child’s having
school difficulty (Beach, Cowen, Zax, Laird, Trost, and Izzo, 1968).

To evaluate the effectiveness of the early identification procedure, RT
and NRT children were compared when they reached the third grade,
more than two years after they were originally classified. Two independ-
ent sets of evaluations were done in 1961 and 1962. Groups were com-
pared on a variety of school record measures, that is, nurse referrals, at-
tendance, grade-point average, and achievement test scores, as well as on
several adjustment measures, that is, teachers’ ratings, the Children’s
Manifest Anxiety Scale (CMAS) , a rating by the mental health clinical
team, Thinking About Yourself (TAY) , and The Class Play (CP) . The
results of these comparisons are listed in Table 1.

This Table shows that NRT children surpassed the RT children on a
variety of indexes in both sets of comparisons, although the 1962 data
showed many more differences between the two groups. Within two
years, NRT children were achieving higher than RT children, were rated
by teachers as better behaved and better adjusted and, for the 1962
group, were regarded more positively by their peers as measured by CP.
The adjustment measure used by the mental health clinical team also
showed significant differences. This judgment was contaminated, howev-
er, by the team’s knowledge of which students were RT and NRT.

Stability of differences between RT and NRT groups was tested by a
further follow-up of the 1961 to 1962 samples when the children had
reached seventh grade, about six years after they were originally diag-
nosed and four years following the first evaluation. By the time of the
seventh-grade evaluation, group sizes were diminished by attrition but,
since no sipiificant differences on third-grade measures were found be-
tween pupils leaving the E school and those still present, the group re-
maining was viewed as representative of the original group. A summary
of comparisons on which significant differences were found among the
seventh graders is listed in Table 2.

The data from this table- indicate that by seventh grade the NRT chil-
dren were still surpassing the RT children in school achievement, and in
adjustment as rated by teachers and peers. Again, these findings were
consistent for the two independent samples. To determine whether the
achievement and adjustment of RT children had progressively worsened
between the third and seventh grades, the difference scores between third
and seventh-grade measures for RT and NRT children were compared.
No significant differences were found in these analyses, indicating that al-

Table 3 E and C School Comparisons for 1961 and 1962 Third Grade Groups

1961

188 / secondary prevention m the schools

Table 2. Significant Differences in Seventh Grade Data between RT
and NRT Children for 1961 and 1962 Groups (From Zax
and Cowen, 1969)

1961

1962

RT

NRT

RT

NRT

Criterion Measures

X

X

t

X

X

t

Nurse referrals, fifth grade

218

92

2.26

_

_

Nurse referrals, seventh grade

—

_

_

1.81

31

3.58

Nurse referrals, total

_

_

813

3.71

2.78

GPA, fourth grade

_

_

_

3.28

409

253

GPA, fifth grade

—

_

_

3.22

4 13

3.40

GPA, sixth grade

3 65

4.10

2.32

3j06

4.02

2 91

GPA, seventh grade

3 35

3 88

2.17

310

3 87

2 96

GPA, total

_

_

_

3.12

4.10

317

SRA, seventh, language arts, grammar

30 18

34.90

2.54

33 00

36 82

2.02

usage

SRA, seventh, language arts, spelling

—

_

_

13.93

18.15

232

SRA, seventh, arithmetic, concepts

12.42

15.34

2.24

_

—

SRA, seventh, arithmetic, reasoning

18 33

2219

219

_

_

—

SRA fifth, arthmetic, reasoning

23 27

27.87

211

_

_

—

SRA, fifth, arithmetic, concepts

_

—

_

9.92

11.97

2.19

Teachers' rating (total)

13 95

5 61

3 41

_

Teachers' rating (overall)

3 48

251

3.20

3 31

2.39

2 76

65 05

44 73

2 35

58,07

34.59

240

though the RT children were performing consistently more poorly than
NRT children in a number of respects, their performance had not wors-
ened over the years. They seem to have made a poor start in school and
to have never caught up with their better adjusted peers.

The preventive aspects of the Rochester Primary Mental Health Project
have gone through, at least two distinct phases. The initial program was
broadly gauged and directed primarily toward school personnel and par-
ents Fundamental to the preventive program described, as well as to the
form adopted later, was the reshaping of the mental health professional’s
role from one of a direct service giver to children to that of consultant
and resource person for others who provide service to children. Every ef-
fort was made to bring mental health personnel closer to teachers and
school administrators At the beginning of the school year, informal
luncheon conferences were held with first grade teachers during which
they could talk about children who were causing concern. Often the
school principal, the nurse, the attendance teacher, and various other spe-
cial teachers were present. These conferences later assumed sufficient im-

THE ROCHESTER PRIMARY MENTAL HEALTH PROJECT / 191

measures taken from their several years of schooling Table 4 depicts the
results of these comparisons

Fourteen of the 46 comparisons between E and C school students re-
flected significant differences, although the pattern of differences is not
clear cut The E school children were found to have lower grades, were
more likely to be underachievers and had poorer attendance records
than C schoolers On the other hand, they were less anxious at the sev
enth grade level and scored higher than C school children on several
standard achievement tests It was not possible to do an adequate follow
up for the 1962 group because of the high degree of attrition in those
classes Thus the results of this fairly long term follow up did not lead to
definitive conclusions The relatively weak folio v up findings may be t e
result of program inadequacies or the high attrition rates Whatever t e
reasons, the positive effects of the preventive program were not demon
strated to be enduring with respect to the measures used

Partly because of these inconclusive findings and partly because those
children identified early as RT youngsters continued to lag ; behind their
NRT peers by seventh grade, despite the fact that they ha cxpe
the preventive program, the tom of the Rochester primary m«i,al heal^
program was altered One major problem was .hat it provided relatively

Table 4

Significant t Tests Resulting from W™°" s ’■*

Subjects in the 1961 Group (from Zax and Cowen, 1969)

Criterion Measures

X (I) x IP)

School record measures

Nurse referrals fourth grade
Nurse referrals seventh grade
Attendance 61-62
Attendance 64-65
Attendance total
Grades fifth grade
Grades sixth grade
Grades total

SRA fifth grade work study charts
SRA fifth grade arithmetic concepts
SRA seventh grade arithmetic reasoning
SRA seventh grade arithmetic « nce P s .

Achievement-Aptitude D score-seventh gm

seventh grade Otis
Adjustment measures

CM AS anxiety seventh grade

156
58
1053
953
39 32
39552
370 92
382 64
1570
1258
21 14
1455
36105

94

255*

158

292 b

754

253*

553

250*

28 43

253*

421 10

2-08*

430 70

3 82*

41146

256*

1356

267*

1172

272*

1852

2 93*

12 97

255*

445 57

551*

15 82

217*

‘p ~ Oo
*f> = 01

190 / secondary prevention in the schools

portance to warrant hiring substitute teachers to replace the regular class-
room teacher while she participated. While teachers learned a great deal
about specific children, they also acquired much knowledge and useful
experience for better dealing with a variety of general classroom prob-
lems. The consulting psychiatrist who served with the project over a peri-
od of many years was often present at these conferences and helped both
with the understanding of specific children and with the general problems
inherent in the teacher’s role.

Also basic to the early program were special meetings for parents and
teachers to discuss various mental health relevant topics (c.g., child de-
velopment and functioning, human motivation, and the emotional and
psychological needs of the young child) . After-school meetings for teach-
ers were led by specialists on topics in which teachers had particular in-
terest. Six evening meetings for the parents of primary grade children
were devoted to the emotional and social development of children and
were also led by specialists in these areas.

Direct service to children was provided in an after-school program to
which teachers assigned students who needed extra attention. This pro-
gram was designed to provide a meaningful interpersonal experience in a
relatively informal setting. Groups were limited to 10 children. The men-
tal health clinical team selected leaders, teachers in the E school, on the
basis of their interest in children and their problems, demonstrated effec-
tiveness in working with the socioeconomically handicapped, and the at-
tribute of being a good mother or father figure. Groups met for one hour
a week for 20 weeks, engaging in activities as diverse as woodworking
and baking cookies.

E and C school children completing third grade in 1961 and 1962
were compared as a means of evaluating the effects of the prevention
program. The results of these comparisons are reported in Table 3.

or the 1961 group, the only significant differences found were on the
teachers adjustment rating and the CMAS A scale. The A scale results
indicate that E school children reported significantly less anxiety than did
C schoolers. However, teachers' ratings indicate the reverse of what was
expected m that the E school children were rated as more maladjusted
than C school children. The results for the 1962 group indicate signifi-
cant differences between E and C school on seven measures, all favoring
e E group. E school children were found to have fewer absences, higher
SRA comprehension and vocabulary scores, better achievement records
relative to their aptitudes, more favorable teacher ratings, and significant-
ly lower anxiety scores on the CMAS.

A follow-up study was done of the 1961 group when it reached sev-
enth grade. Original E school children who were still available in the
school were compared to available C school children on 46 different

THE ROCHESTER PRIMARY MENTAL HEALTH PROJECT / 193

Another component of the revised preventive program is an after
school daycare program staffed by undergraduate college volunteers
The teachers or the school psychologist or social worker select children
for the after school program who seem to need such an experience Typi
cally, these children manifest problems similar to those that prompt
teachers to refer a child to a TA, that is, acting out, undersociahzation,
or poor achievement The format for the after school program has varied
somewhat over the years At its inception, each child was assigned to an
individual college student volunteer who visited him in the school about
three times every two weeks for approximately one and one fourth hours
immediately after the end of the school day Contacts took place in the
school or on the school grounds, where use of many of the school s facih
ties such as the auditorium, gymnasium, shops, home economics room, or
music room made possible a variety of activities As in the case of the
TA program, it was expected that major benefits would derive from the
relationship with an interested, energetic, enthusiastic, young person who
could, hopefully, provide support as well as a model for the youngster to
emulate In a more recent program development small groups of chi
dren, particularly undersocialized ones, have been assigne to sing

""Although a detailed evaluation of the new form of the Ro f e J er F "
mary Mental Health Program has not been made some “ asure ^
bear on its effectiveness are available Four of the ongina l x < home™
TAs are still with the program after seven years , >f of* turn Refe
rate to the TAs has grown to a

necessary Indeed in one school with a t P Another

fewer than 200 children referrals have a PP r ° ucceK ]$ fact that the

fewer than 200 children
measure of the program’s acceptance ana " expenme ntal basis

school system in which the program ongi m severa! mnercity

has hired TAs, with its own funds to fun

schools the effectiveness of the

One objective study has been ° In this study, primary

TA and after school programs (t-owe^ othe r relevant variables were as
grade children matched fo y a S' ( _ s ” ]1 °g e student after school program, or

signed randomly to TAs to

mental groups averaged

to a control condition Children “ Chinnier Program effects were
from 25 to 30 contacts with 1A or a ^ indepel)den tly by

evaluated by a rating on a seven P°‘" ds status for ,he period of
teachers and TAs which evaluated unproved to very much

time covered by the program ( ' d 1( , ac her ratings was 62, which

worse) The correlation between

based on observations in

>e) l iic tunvias. , e Daseu uii

reasonably high, ^considering ^ ratmgs c f t he three S r0 , u P s J” dlC ^ t 1 e

different situations Comparisons

that the greatest improvement

took place

in children

seen by TAs, fol

192 / secondary prevention in the schools

little direct service to children. To provide that service, it was recognized
that considerably more manpower had to be bought into the program.
This led to the recruitment, training, and supervision of a group of non-
professionals who were interested in working with young children. Taking
a cue from the work of Rioch, a group of housewives who had demon-
strated their own success as mothers and who expressed a strong desire to
work with young children were recruited for work as "teacher aides"
(TAs) . Initially six trainees were selected on the basis of their flexibility,
interest in and positive attitudes toward children, and their demonstrated
success as mothers. None had a college degree, and one had not even
completed high school. Their training was limited to a five-week program
intended to provide only a few psychologically technical tools to help al-
leviate some of their anxiety and uncertainty. The program relied heavily
on the natural reflexes and personal qualities of the TA.

At the outset, new TAs were assigned to a specific primary grade class-
room to assist with children who required more attention than the teacher
could provide. When one year of experience with this format proved too
trying both for teachers and aides alike, a new format was adopted and
has been maintained for several years. In the new setup the TA operates
outside of the classroom accepting referrals from the teacher. One conse-
quence of this change has been more constructive TA-teacher involve-
ment around the problems of specific children — as the new system avoids
the conflict engendered by the ambiguous responsibilities, of the two roles
w en operating in the same room. Typically, in this system, the teacher
brings specific problems to the attention of the school mental health
team, a psychoiogist and a social worker, who have overall program re-
sponsibility. In concert with the TA, the teacher, and often a mental
health consultant to the project, devise a set of objectives and a plan of
action for each child. Once this is done, the TA begins to see the child,
perhaps for several one-half hour periods a week. Continual feedback oc-

p^ S am ° ng 1 * ^ A ’ tbe teacher ’ and the mental health clinical team.
Progress is regularly evaluated and goals are revised.

work-in 7, rk h W f the 77’ the TA ° ften be S ins by focusing on school
ooiit a * back S r i our ; d > h °wever, a major emphasis is placed on devel-
that is emotion ally supportive for the
tactsktlen TA sch ° o1 adjustment. Most con-

bene^aT smaTl t individual but > where it seems likely to be

hshed Sor Sf°T haVC formed ‘ Such ^cmps migh t be estab-
Thus the childr^ ™ ^ P articuIarl y timid about peer relationships,

pommhv t T lVe c aSS1Stance with identic problems plus the op-
dire7ninl i° * ^ ^ relationshi P in a less complex and lets

With children jrr em * an * e classroom - TAs are also used to deal
teacher in a large clasS^T^ ‘ hat Can " 0t be handled easily by the

THE SUMTER CHILD STUDY PROJECT ( 195

were evaluated m the spring before entering school on the basis of which
predictions were made concerning their ability to cope with the stresses of
the early school years (2) an intervention phase devoted to planning and
carrying out procedures for helping a particular child with the stresses to
be encountered and (3) an evaluation phase concerned with measuring
the effectiveness of planned interventions
The preschool evaluation phase of the project involved two 45 minute
examination periods The first was directed toward the child who was ob
served in a structured situation and tested by a psychologist while his par
ents were interviewed by a psychiatric social worker The second 45 min
ute period involved a meeting of the evaluative team members whose in
dividual impressions were distilled into a final team summary concerning
the particular child Later each team discussed the child s record with a
group of consultants consisting of a regular project staff member a pe
diatrician and a child psychiatrist Each team was required to make a
rating that predicted the capacity of each child for adapting to t e sc oo
situation A four point scale was used (1) exceptional (2) typical (3)

weak and (4) trouble

Interventions were designed at times for the entire P r °J chl j

times for specific subgroups within the total an at ° - children

dren One example of an intervention directed toward a^group of children
involved several youngsters who had been i enti e ^ f

and so deficient in adaptive skills as to be particular “
tenng the typical school situation These c 1 ren the f a ]j j n this

week summer program in the school they wou a h k d c f

program a teacher attempted to work with

social skills and competencies in han mg * subgroup consisted of

in a larger group of -ore adequate peei ^s Another su*
children having speech difficulties P therapy prior to the

advised to provide their children with inte nem.on for many

child s entering school The striking ene e speec h therapists by

children eventually led to the hiring o wo %vere lf i en tified as lack
the school system A third group o c 1 through their parents These
ing m important social skills Jj al ‘ n '“ ghb orhood pliy groups church

parents were guided in using mf , yn( . n ences iMtlun the famil) and

programs family outings separation ^ ennc hmcnt experiences for
the pooled efforts of groups of P^ en d , sa dsantaged parents who
their children Finally socioeconomics ) ^ much of

could not afford prnate kindergarten ^ readiness of their chi ren

their own time to enhancing 1 e P department which esnblis let a
were assisted through the city recrea 1 a{ fostering essentia so-

program for preschool ch, ' d ^ v * a ne ,ghborhoods
cial skills in children from dep

194 / secondary prevention in the schools

lowed by those seen in the after school program The youngsters m the
control condition remained essentially unchanged Ratings of TAseen
youngsters were not significantly better than those m the after school pro-
gram but were significantly better than those in the control group Chil
dren in the after school group did not show significantly greater improve
ment than the control group In a later study, children participating in the
after school program for five and one half months (Cowen, Carlisle, and
Kaufman 1969) showed significant improvement as judged by teachers
and TAs

In its most recent phase the Rochester Primary Mental Health Pro-
gram has concentrated on training school mental health professionals to
adopt the role model established in the program The preventive program
has been extended to II schools 6 m the city of Rochester, and 5 in
neighboring county school districts The location of these schools ranges
from the inner city ghetto to the affluent suburbs This program should
provide valuable information concerning the differences in approach and
types of personnel that will be most effective m the various settings In its
latest form about 55 nonprofessional child aides have been trained with
approximately one fulltime psychologist one fulltime social worker
an 10 TAs available for each 2 schools in the program In addition to
extending the old program the new one is intended to develop primary
intervention approaches These can come about through studies of the
nature of the school and classroom structure through efforts at building
psychological strength and resources m children by reinforcing curiosity
or a truistic responses and through improved means for handling crises
(Zax and 1Q79\ °

THE SUMTER CHILD STUDY PROJECT

deVel °P <:d ln Sum,CT County South Carolma in the early
ierse ei^ W °™ 1%7) was c °"“rned wtth prevent, ng ad

a P artlcular crisis faced by all young children
lv to ha "h y BaS1Ca U y the Pfogram s aim was to identify children like
in overcom f dlfficult >' ln managing the crisis and to assist them

become L” , P™ 8 ™” ™ 5 baSed on the assumption that what

Mu” , olr P a J ° r Chlldren fr «P>Mly had originated from a
in beginmng^e schooi a «penenc” e S,tUaU °" ^ ^ that 1 "'"’ h ' ed

with the support of the

as a mnrW emal Heaith The program s purpose was to serve

It had three phases "fitT' 10 "! “V” presch ° o1 and earl y sch ° o1 f ears
P (I) an early detection phase in which all children

(b) Speech evaluation by state speech and hearing team helped parents to
be more realistic {if not more helpful) about speech handicap, and mobilized
school efforts for therapy (school system hired two full time speech therapists)

(c) Development of a new city recreation department program for pre
school children provided Lemar's first supervised social experiences as well as
enrichment and learning opportunities

(d) Development of the new preschool summer program (six weeks) in the
school he would enter provided (1) a gain in school behavior orientation, (2)
easily reached goals to build up achievement skills, and (3) maintenance of
mother's positive motivation His IQ was raised 15 points accor mg to
testing

2 During School Entry . , , , , . „

(a) Place Lemar w,th teacher accept, ng of d*™d chta j*

may need special tolerance and handling at first, parents need, 1 "“T"’
their negative feelings easily aroused, except need to handle communication

distortions <- t r " nroqram, aimed at early

(b) Enrolled m the Junior League Big P £ hlIdre „ (facilitated

attack on school dropouts by interest in depnv human interest and

by the pilot program of current PK>M en ^ Qnd fl blrt hday cake
strategic resources, for example, extra h|S schoo | to build up hygiene

(c) School nurse checked on regul physician samples

and body health, initiated o vitamin P r °9 r ° m , n tervals to teacher ond

(d) Interventionist was available at g

parent, especially if distress signals occurre ^ sigw ficantly no behavior

Outcome School entry was minimally adeq , ^ Dlfficu | tl es arose

problems or distress signals occurre rom ^ p ra matic progress gradu
with family school communication but were re ^ n ow , n second grade,

ally occurred with speech handicap Reped ^ « defec)jve j, happy and

functioning as a slow learner but e ®"£ remains unchanged mother after is
well motivated, never misses schoo employment family remains

PTA regularly and continues to progress with empl

welfare rolls

Figure 3 An Intervention program for a sp
1967 pp 518 519 and 520)

of the program is pa« ! V obj ““ gy^FoUmv ups base

compared children whose g ° either exceptions

t„er P l or 2, reflecung o[

children whose ratings were 30 ^ ua completed

ble Children regarded as typical

duld (&«a N™" 0 " and Bnn ™

196 / secondary prevention m the schools

Many children with unique problems were dealt with in programs es-
pecially designed for them Part of the preschool workup by the project
team involved offering three or more suggestions for enhancing the
child's readiness for entering school These suggestions were conveyed to
the parents, and follow up interviews were scheduled to discuss the out
come of suggested interventions Parents were very involved in tins proc
ess and only a few of them (2%) failed to meet their appointments for
the follow up interviews An example of a program to meet the needs of
a specific child is described in Figure 3

(Lemar)

Preschool Checkup A walking index of poverty, undernourished, cleaned up
for the school visit, speech incomprehensible, suspected mental defective, im
pulsive, functioning well below norms in all areas A grim mother determined
that her child succeed in school, suspicious of rejection and easily antagonized
Married at sixteen to a man twenty five years older, after five children is tired
and worn at twenty six Husband is currently unemployed and in jail, family has
moved four times in the last year, is currently living in three rooms, and obtains
water from a neighbor Parents quit school by the fifth grade Little resources
beyond existence and impulsive moments of pleasure, known to welfare sources
o be in a chronic state of crisis Team predicted little chance of school success
without major interventions Most significant strengths are child's energy and
mother s determination for school success

Needs So excessive in all areas the problem will be to remain focused on school
mess an a realistic school program, rather than to become overwhelmed
by family needs

Interventions

J^r ed , Wel , f ° re "“T ™ n ° sed ,0 su PP'y '"mediate food need The first
u a $lmple ' eas,ly a,,amed '"fervent, on that responded to urgent

needs but did not prom.se more then could be del.vered ond was ,n line with

memwr% ^ VmS ,he P resch ° o1 P^col at the local county health depart
men, was effective ,n establishing a working relationship between mother, school,
ond n erventionist asweN os a build up of body health as a readiness resource
„ , 7 Tl , Interventions focused on key behavior agents using existing
or specially developed resources

1 Prior to School

read I npl C ; 0m T Un ^ at,0n ° f Pr0 ‘ eCt and sch ° o1 effor * toward Lema* school
and Int 5 mU r ® newed welfare interest leading to mother's employment
and later, minimal welfare contacts

CONCLUSION / 199

flow of clinic'll refemls to vastly overburden school mental health work
ers Many of these programs seem to have proceeded on the blind faith
that earl) intervention is worthwhile even though some question this as
sumption and few have been able to offer pragmatic ideas about how to
intervene at the outset

The oldest secondary preventive programs have undergone several meta
morphoses as a function of specific experiences Many of these pro-
grams have produced convincing evidence that children with problems
can be identified quite early in their school careers and that such prob
lems tend to endure These findings affirm the vvorthwhileness of attempt
ing 10 develop effective secondary preventive programs a point that
might have been disputed a few years ago when some argue t at a
child s problems are so ephemeral as to be unworthy of preventive ef

forts , ,

One might well ask however given the experience of the programs de
scribed m this chapter Where do we stand with respect to t e P
for preventing early identified disorder? Clear y '^ograms su^eyed
have not yet produced results that are sufficient y cone usive (ar

complacency Program efforts might be teachers

gets or on some combination of all of in 1 \ , d Iareely

and the children themselves The St Louis ran ‘ oon«n.ratedj argely

on parents and created a format group h f nd a similar f orma t

ficial to a certain class of parents On results Although

with other social classes produced very lsa PP ents f or the most

other programs have made weak ■ atte ™P t ' b ° mode! P for a secondary pre
part we are still without a widely app • extensive Most of the

ventive program in which parent invo ' ? hcre have done relatively little
secondary preventive programs elese i . eac j, ers by mental health pro-
direct work with teachers Consu tation v ^ preventive effort does

fessionals in the course of carrying out a ^ (ruly systematic efforts to
take place however no program is mvo Savior modification pro
work with teachers as has been one in tllJS IS another aspect of

grams discussed in the previous c ap er ^ creation of new program
secondary prevention that could ene

models and research into their effectivene man ifesting school prob

It is with respect to direct work with ^ most The Roch

lems that the programs described have “ ^ ^ pACE progr am and

ester Primary Menial Health Project as | « drf [he mode , „f a profes

the Sumpter Child Study Project have all P f ^ [radltl0nal sc hool mental
sional role which is more active than mtervenlion and a tar.

health worker It is a role modcl tha t«coura^s„ ^ ^ ^ Rod
ety of efforts to bring beneficial fora* • r alde who can provide

ter project has also provided the mode!

198 / secondary prevention in the schools

the first grade reading requirements as those seen as weak and m trouble
Only 2 9 percent of the children rated as typical failed to complete read
mg readiness primers whereas 28 percent of the children seen as weak
failed Furthermore the higher rated children had significantly fewer
school absences and 94 percent of them were promoted whereas only 66
percent of the children with poor ratings were promoted Children rated
as weak were found by the assessment teams to have revealed m the psy
chological tests either negative or unrecognizable feelings concerning
school and seemed to have particularly unrealistic impressions or con
cepts about school They were also found to be lower in initiative were
either over or underresponsive to adult wishes displayed less independ
ent behavior were less satisfied concerning their own age status, were
lower in curiosity and were consistently seen as poorer in functional uses
of the body and social development than were their better rated peers
They were not regarded as less intellectually capable however

Most of the above mentioned findings support the validity of the early
detection procedure The success of the intervention is reflected in the
parents very positive reaction to the program Also demand for services
increased in time and the number of interventions per child seen in the
preschool checkup increased substantially in the second year of the pro
eram ' *

c,°" h rh M 1S c° f , he ‘^ “i Koence Wlth 'he program the designers of the
rater Child Study Project believe that they have helped validate the
general principle that confronting stress and developing techniques for
coping with its effects are budding blocks for maturity They see the
aeemem^H 1 ‘T/’ bei " S m ° re effectlv « ‘han treating’ it Man
blazon th cTra 8 !, fr ° m treatraem ‘n 'hat it involves bringing to
tract " h h S r 0blemS <he resources of a » *e individuals who in
Thdicaul r r ln v‘i 3lly hfe S “ Ch as P a ™“ a nd tehees instead of
exnert i hL u 'J £ ° r deahn ® wlth ■» Problem to some outside
child is the m e "i* '7 €m P hasls on managing rather than treating the

beha™ , n ,b I*' Mpln S the develop spontaneous coping

promouni frant are d a -'-ally occurs is more conducive to

men7of"n S .eht nth Pt,Ve and res ° ura fulness than is the develop
ment ot insight in the conventional treatment situation

CONCLUSION

efforts with chdH* ^ be f ° the locus of Significant secondary preventive
few lnstances and""' *** ,den “ fica "°" has received major stress a
many cases Drnm- P rc '' en “ on has been the prime thrust in others In
P grams a\e emerged as almost frantic efforts to stem the

REFERENCES / 201

Gildea, M C-L. Community mental health a school centered program and a
group discussion program Springfield, 111 Charles C Thomas, 1959

Gildea, M C L., Ghdewell, J C, 8. Kantor, M B Maternal attitudes and general
adjustment in school children In J C Ghdewell (Ed), Parental attitudes
and child behavior Springfield, 111 Charles C Thomas, Publisher, 1961 Pp
42-89

Gildea, M C L, Ghdewell, J C, 8. Kantor, M B The St Louis mental health
project history and evaluation In L L Cowen, E A Gardner, 8. M Zax
(Eds), Emergent approaches to mental health problems New York Apple-
ton Century-Crofts, 1967 Pp 290-308

Ghdewell, J C , Mensh, I N , 8. Gildea, MCL Behavior symptoms in children
and degree of sickness American Journal of Psychiatry, 1957, 114, 47-53

Newton, M R, 1 Brown, R D A preventive approach to developmental
problems in school children In E M Bower, 8. IV 7 G Hollister (Eds),
Behavioral science frontiers in education New York Wiley, 1967 Pp

499-527

Rae Grant. Q, 8. Stringer, L A Mental health programs in schools In M F
Shore, & F V Manmno (Eds), Mental health and the community
problems, programs and strategics New York Behavioral Publications, 1969

Pp 83-102

Stnnger, L. A Academic progress as an index of mental health Journal of Socia
Issues, 1959, 15, 16-29

Zax. M, & Cowen, E. L Early .dent.6cal.on and prevention of emonomd
disturbance in a public school In E. L Cowen, ar ncr ’ y .

(Eds). Emergent approaches to mental health problems New York
Appleton Century Crofts, 1967 Pp 331-351 ,

Zax. M . * Cowen, E. L Researd. on early deletion

dysfunction in young school children Academlc

topics in clinical and community psychology

Zax,M, 9 & P awen!°F 8 L Abnormal psychology changing conceptions New York

Holt, Rinehart, 8: Winston, 1972

200 / secondary prevention m the schools

a great deal of attention to the child who needs such help Extensive
work has proved this model to be altogether feasible, and even should the
long range results of such a program be less successful than desired, new
types of programs will very likely adopt the teacher aide model as a
means of bringing concerted attention to the problems of the young child
In summary, the secondary preventive programs that have been re-
viewed are far from finished products m which to repose all of our faith
On the other hand, they do represent some interesting beginnings suggest
ing that many innovations are possible for dealing with the troubled
school age youngster when his problems are first recognized rather than
only after they have become exacerbated to the degree that referral to a
clinical facility becomes necessary

References

Beach, D R , Cowen, E L , Zax, M , Laird, J D , Trost, M A . & Izzo, L D
Objectification of a screening procedure for early detection of emotional
disorder Child Development , 1968, 39, 1177-1188
Bower, E M Early identification of emotionally handicapped children in school
Springfield, 111 Charles C Thomas, Publishers, 1960
Bower, E M , & Lambert, N M A process for in school screening of children with
emotional handicaps Sacramento. Cal California State Department of
Education, 1961

Brownbndge, R, & VanVleet, P (Eds) Investment in prevention The
prevention of learning and behavior problems in young children San
Francisco Pace ID Center, 1969

Buchmueller, A D , & Gildea, M C L A group therapy project with parents of
behavior problem children in public schools American Journal of Pry
chiatry, 1949, 106, 46-53

Cowen, E L The effectiveness of secondary prevention programs using
m thC SCh ° o1 SCtting Proceedm gs, 76th Annual Convention,

AP A, 1968, 2, 705-706

Cowen, E L , Carlisle, R L , & Kaufman, G Evaluation of a college student volun
p" J >r ? gram ™ primary graders experiencing school adjustment problems
Psychology in the Schools, 1969, 6, 371-375

COWe ";f , L ; L D ’ M,les ' H ’ Telschow, E F , Trost, M A , & Zax, M A

Inurn i /V in school setting description and evaluation

Journal of Psychology, 1963, 56, 307-356

, E L, Zax, M , Izzo, L D , & Trost, M A The prevention of emotional
aisomm m the school setting a further investigation Journal of Consulting
Psychology, 1966, 30, 381-387

PREVENTION IN THE COLLEGE COMMUNITY / 203

certain as to whether to view the student as a child or an adult. Given
these conditions, it is reasonable to suppose that the psychological re-
sources of the student may be greatly enhanced or sadly damaged by the
nature of the experiences that occur during the college years. The com-
munity psychologist may be well justified, therefore, in viewing the col-
lege population as deserving relatively high priority for efforts at preven-
tion.

The portrayal of the college student population as a "high-risk group
is based on more than speculation about the stresses of college life. Statis-
tics on the rate of identified emotional disorders among students indicate
that the rate of incidence is higher than for the population at large (Reid,
1970) , although these data may be misleading because of inequities in
the processes by which problems are identified in the college community
as opposed to other communities. There can be no doubt, howeser, t tat
the incidence of psychological disturbance among college students is su >
stantial. Based on the findings of campus mental health xsvica oSawg
comprehensive programs, Farnsworth (1966) has estimate t la ° r
ery 10,000 students, up to 1650 may be impaired to the de «"* * at *
require professional help or cannot function effeeme y as s u ’

20 may attempt suicide, and up to 25 may require treatment tn a mental

hospital. When one considers that the Unite tales
uref placed the college population at ^03^

rates such as those cited above would indicate collcec

of individuals will experience substantial

years, not to mention the unknown ""^“^‘"^xperience later
college before their problems are identi , college experi-

problems beeanse of the adverse effects of an tnadcqua.c colleg F-

en T e he existence of a substantia, need

colleges does not in itself imply the n “ . for stm ] cn t population!
vention. The concept of preventive P i n SKOrI i,, ]90G) . and
dates back to the early decades of this cc n ^ ^ American
mental health facilities are hard y no arc a( j C q Un te to meet

campus. Yet it is doubtful that existing : P ° ^ dcman d for psycholog-

present and future needs. On one ian . r jpzin. and Fox (1967) found.

ical services may be increasing. Cl cr * .- j, c jp from the student
for example, that the number o stu< c ” xr or( i, Carolina increased from
mental health sen-ices at the Um'ersit} ^ j n j065. Manpower re-

about 18 per 1000 in 195G to about « P ^ inu ,fficient to meet in-

sources in the mental health fie is toa a j pj an , for delivery- On t ie

creasing demands for sen-ice unt cr nt jy available. may not *• c

other hand, existing services, cxen « siut lcnt» who could bene it r
signed to reach a substantial portio

8. prevention in the college community

tervention aimed a^children^or *' d,5C “ ssed P ro grams o£ preventive in-
reasons, both theoretical and * yo . ung adoIescents - There are impressive
age oi 'our ‘ h “ * «“““ ^

services for the very vounv Rn should be committed to providing
present a picture of need and an 5 °™ ewhat old er populations also
development of innovative programs of' ^ ™ PaCt ‘ ha ‘ warrant the
college students is one in ° ^ prevention. The population of

another) . College students 'a Cat ' S<>ry (armed services personnel may be
great number rf £^ ( £I5p\ , “ 5r SU **“ “ a " — 1 Hy

doubts and conflicts over matters such StUdent 15 made anxious by
bavior, and separation from Ir i, “ occu P a tional choice, sexual be-

unlikehis WO rLr P eers the collt° m rr mUnity < Rdd ’ I97 °> ' Als °’

demands of his school and, often to “" denl .‘s ubject to the academic
w l ion in which parents rniiL«- ’a: the confusion arising from a situa-
• ge staff, and the student himself may be un-

PREVENTION IN THE COLLEGE COMMUNITY / 205

directed by community psychologists at their own base of operations, and
so many efforts have been directed at communities with which the pro-
fessional is likely to be relatively unfamiliar.

Perhaps one reason why the university-based community psychologist
has not always sought to work in his own institutional community is that
his more intimate knowledge of the setting may be negated by the unique
problems in acting as change agent for a system of which he is an integral
part. Brigante (1965) has described various ways in which campus men-
tal health workers may be viewed by other members of the college staff
as usurpers of prerogatives or narrow stereotypical figures who implicitly
belittle academic concerns by their emphasis on hidden motivations for
behavior. Moreover, Brigante notes that, as with any community, the
goals of the mental health worker may be regarded by others as super-
fluous or even contrary to the goals of institutional leaders. For example,
he cites the possibility that the community psychologist may be viewed as
fostering dependency or excessive emotionality in an institution w lere
academicians may feel independence and a capacity for detached intellec-
tual assessment of problems should be fostered. .

Whatever the virtues and drawbacks of attempting to eve op \
tive programs of preventive mental health in the co eges, ’ e
mains that relatively few exclusively

pected, however, that there have been a num er o P ^ ^

have earned obscurity because they could not “V (c> be descr ; be d

demonstrate positive impart. 0 n the basis of their ef-

in this chapter hardly qualify as great viluable lesson to the

fects and longevity. They will, reasons

reader who asks a few appropriate qu pro j ec t and what was their

for the different outcomes. Who ins iga did the plan of in-
prior relationship to the community , „„rferistics of the campus

tervention reflect a concern for the unique ^ a j ter t j ie workings of
social system? How broadly did the projec rec jpj e nts in the com-

the community? Finally, were the poten workers, or advisers, or

munity given input into the program as p

did they merely constitute the target o reflects an editorial effort to

The development of this chapter P ar 1 t j ie programs described are
ask and answer the questions above. m * , . ted consideration of com-
those that only minimally illustrate * s ° . the chapter, to a point, pro-
munity intervention issues. Progress. 1 recognition of the questions

vides illustration of programs invo vmg j n t h e ir efforts to inno-

that community workers may be obliged t ^ projeCts that derive a
vate. The last part of the chapter e

204 / prevention in the college community

psychological assistance, but who would not seek out the types of services
traditionally offered by campus agencies Kysar (1966) , for example,
argues that the college facilities may be reaching too few students whose
“psychosocial difficulties’' lead to their dropping out or flunking out of
school

Beyond the issue of need there is another standpoint from which the
college campus represents a logical setting for programs of prevention
The campus may provide an excellent laboratory for discovering and
demonstrating the means for effective psychological intervention (Lever
idge, 1957) Larson, Barger, and Cahoon (1969) have cited three ways
in which the college setting lends itself to the work of developing a para
digm for community mental health services generally First, the college
community provides a relatively small, homogeneous and stable popula
tion on which research data may be collected with comparative ease Sec
ond, the college is already well staffed with helping agents, such as chap
lams, residence hall advisers, and administrators, whose functions might
be altered to reflect the new concepts of service undergoing trial Third,
t e college community as a setting for experimental interventions is ideal
or training workers among the population of preprofessional students,
an these workers could then carry their insights into other communities
where new modes of service may be needed

The idea of using the campus as a proving ground for principles of
community intervention raises the question as to whether the campus is
an appropriate analogue for communities generally In certain respects,
even t e large residential campus differs from other types of communi
ies, only part of the population lives within its confines, most of the resi
dents retain other home addresses and the student population is commit
ed to only a limited, predetermined period of community membership
Nevertheless, the campus structure permits the identification and study of

concern, Z a 3 " 1 ”* °" whldl aU communities vary Klein (1965) has
P , a Ize a number of community characteristics relevant to pro
denutv ,„rr nU ^ merUal health lncludl "S physical sire, population
rd7ower ‘ d n "T” gUldmg values distribution of authority

and Z col, P ° £ communic a,.on On all of these dimensions,

poL ha 'hum n “ mPUSeS may Vary w ‘ deIy Kelly (1966) has pn>
atmZtes as sTh COmmum , t , 1<:5 be ™„ed as ecological systems, whose
“eZnt ve effort Z T Wdl the feasibility and impact of in
fZ whmh ' 35 " 15 trUe ,here 15 £“«her perspective

mumty nsvcho? ^ may ^ a umt I uel y desirable target for the com

gists operate o°ut ofunwersiues ' ' b COmmumty P^ 0 ^

larlv am to .1 Sltj es, it is to be expected that they are particu

is somewhat iron * ^ om P Iex realities of their university community It
ic, t erefore, that so few efforts, relatively, have been

PREVENTION IN THE COLLEGE COMMUNITY / 207

effective in improving academic performance as measured by discrepan-
cy between predicted and actual grades in the first year. The experimen-
tal and control groups were essentially similar on this dimension. It was
found, however, that the controls tended to seek more psychiatric help
than the experimental subjects or the average freshman. Retrospective
analysis of this finding led to the conclusion that the control subjects were
not more disturbed than most of their peers but, instead, that they were
more inclined toward seeking psychological help than were the nonvolun-
teering students. Generally, the volunteering and nonvolunteering stu-
dents were found to be similar except for the difference just mentioned.
In comparing high and low attenders among the experimental subjects, it
was found that students predicted to do exceptionally well academically
tended to be in the extreme groups with respect to attendance; that is,
they either attended no sessions at all or they attended six or more, tu-
dents of lesser presumed potential were more often found to attend one

to five of the sessions. . . . f .

Although the MIT project did not demonstrate that a brief, proles -
ally led series of discussion groups would marked y en anc ®. c f *.
mem of college freshmen, it did prnvide valuable «" onna ton for the

planning of future interventions. In ,, r 0 ° Drog rams of

and Harris study suggested that selected
psychological intervention may not be more nee u o
volunteers, but may be more psychologically _ m.ndec
would more likely seek some form of counseling t ^

are likely seek, some iorm ut ° volunteer

dent. The practical implication of this needs for some form

discussion groups may not meet the total co individual counsel-
or preventive intervention, but lessen the e inc lj ne d to seek these

ing by meeting the felt needs of students otherw.se mcl.ned

Servkes ' . , fIT oroiect retained two significant

Despite its innovative aspects, tne i h ^ on( line wor kers in the in-
features of more traditional approac ies. ^ p ro j e ct was struc-

tervention were highly trained professiona 1 ' ^ stuc j e nt life within

tured without any particular regar to ' e jgggx W as somewhat more
the institution. A more recent effort (v ° * structure of the in-

traditional with respect to both the personnel and

tervention. was directed at male col-

As with the MIT project, Wolffs P r * students> in this case at the
lege freshmen. Again the experimental IF ij ^ ticipa te in discus-
University of Rochester, were volunteer. * In P the Rochester pro-

sion sessions focusing on interpersona dormitory resident advisers

ject, however, the groups were le & opposed to the more expe

or graduate students in clinical psyc ° 1?urt j ienT1 ore, the Rochester inter
rienced leadership in the earlier e or

206 / prevention m the college community

special status from the fact that they were staffed or instigated from with
m the segment of the community which was the target group for service
Webster and Harris (1958) reported a program that like many of its
successors represented an effort to reach freshmen entering college in
this instance a male population at Massachusetts Institute of Technolo-
gy The program was seemingly intended to have both primary and sec
ondary preventive functions and the report described three years of pro-
gram operation from 1953 to 1956 The program was hypothetically
open to all incoming students who chose to volunteer for what was pre
sented as an experiment in group psychodynamics Of 3000 students
admitted to the college during the project s first three years 650 volun
teered to participate m the experiment Of these volunteers 227 were
assigned to participate in group experiences led by several psychiatrists or
psychiatric residents Of these 45 never attended a single session be
cause of scheduling administrative problems or a change of heart Vol
unteers who had not been randomly selected to participate in the first se
mester groups were regarded as control subjects
The groups varied in size but a membership of 10 was typical The
groups had autonomy with respect to frequency of meetings with the re
suit that the number ranged from 4 to 27 sessions during the semester
roup ea ers were instructed to present the meetings as an opportunity
or the students to become acquainted share thoughts and engage in dis
cussion of ways of relating to each other Webster and Hams reported
impressionistic data that discussions tended to focus on school related
matters and did not strongly resemble the interactions of a psychotherapy

f S t0 ^ ter J Tline impact of the project on participating fresh
determ^ 6 if Ut researc b em phasis focused on the question of what
whether f W 1Ct 3 student wou ld volunteer and what determined
ResearcherThrd ir WOuld attend meetings regularly or irregularly
dudimr tlieir n CCCSS t0 j 3 vir,ety °* data on ah incoming freshmen m
adm sin inmr ge ^ T perSOnal,ty ™ in s s (based on assessment of
l ^ T enals) names of students dropping or

sough, ,nd,v,dual n p 8 s”hol^l^em™ ^ n ““ StUdentS Wh °

crrlctof drD S roL COInPar , 15 T made m opting to detenmne the
the ™ l P n ,T ”, Wh , ,Ch StI ' dems were b <4 reached by „ F.rs,
ond llUolunteer C ° ntr ° ot ™lunteers were compared Sec

mm citss F ' Z'T, "“'“i thc ^ ‘hetr fresh

d.udctl tccouhn" - f " ho llad assigned to groups were

tenders and comparcd req, ' enCy ° E aC ‘ Ual ' lt,entht,ce h.gh and low at

The findings of ,h ls early study dtd not show that the mterventton was

PREVENTION IN THE COLLECE COMMUNITY / 209

Your Name

Instructions: For each of die categories below place the names of
as many members of your dormitory corridor who fill
the description.

1 . Would wont as a roomafe:

2. Would want in a dub that you belong to:

3. A warm person:

4. Involved with others on your corridor:

5. Cooperative.

6. Keeps to himself:

7. Trouble Maker:

8. Hard to get along with:

9. A cold person:

10. A person you try to avoid being involved with:

(Wolff, 1969; Appendix)

Figure 1 . Soriometric Instrument used in the Wolff Study (Wolff, 1969).

ments were again administered, including the (ex .

to all corridor residents. The members of •mentals with resident

perimentals) with graduate student ^[^^ nteer controls) were
adviser leaders, volunteer controls, and measures.

compared on the basis of change scores for tie prep , the sociometric

The principle findings of the WoIff — The ^

ratings of the group participants as co p than did cont rols in

mental groups showed a significantly grea where the person was not
the percentage of ■•favorabIe , ' choices 5 ’ PJ ]e roles to w hich group
the first choice listed. The percentage o dec ii n ed more for the two
participants were assigned as nonhrs ontro ls than for the volunteer

experimental groups and the nonvolunteer c fellow group members

controls. There was also evidence to group participants. In

were particularly apt to rise in the ,i, e group experience had

general, the sociometric data suggeste s were perceived by both

positively affected the way in which par 1 p ^ fhat this increase in fa-
participating and nonparticipating P ee ”' first choices may have in 1-
vorable judgments were detected on y tIie m0 re favorable ratings

cated that the group members di no the:ir corridor peer group,

by becoming unusually salient mem

208 / prevention in the college community

vention involved natural groupings of students, specifically groups of stu-
dents living in close proximity to one another along a corridor in a dor-
mitory.

Student volunteers for the groups at Rochester were solicited from
among the populations of 10 residence hall corridors. On two of the cor-
ridors the volunteering students were told that the group experience
would not be available, and this group became the nontreatment control
for the study. An additional control group of nonvolunteers were recruit-
ed to take the test instruments without participation in any group experi-
ence. Each control group consisted of 15 students.

Volunteers from the remaining eight corridors became eligible to par-
ticipate in the group experience. Of the volunteers from these corridors,
13 were ultimately eliminated from the study because they did not com-
plete the research questionnaires or failed to attend more than half of the
group sessions. The final experimental sample consisted of 58 students.
Each corridor had a group of its own with 8 to 10 participants. Four of
the corridors had groups that were led by the clinical psychology gradu-
ate students. The groups on the other four corridors were led by their res-

The resident advisers who were given responsibility for group leader-
ship were not an unselected sample. Like all such advisers, these individ-
uals were junior or senior students who had received some initial didactic
training for their job as dormitory personnel. The four chosen advisers,
owcver, were men who were rated as being more effective by the dormi-

mad,LT? S !T t0rS tha ." tlK ? dv ' 5ers on the corridors with groups led by
; . S , U .™, tS ° r t le a dvisers on the control corridors. The four ad-

w«r m Of t had n0t had P rior formaI group experience nor

were any of them psychology majors.

ent C onThl £ ° CU - ,° • ** W ° Iff Study was the im P a « of the group experi-
eddems Priorm r te R raCti ° nS - and mUtUaI Potions of the Corridor

all of the re' u first ” eetl "S s of 'he groups, all of the students on
an ot tne 1 U research corridors were ^ „ , . . .

strument shown in Figure 1 In Jhu* to complete a sociometnc in-
fer the Broun? j ’ ° add,tlon » students who had volunteered

asked to lt°, agrCed fiU out the 'est instruments were

ways of spending their S .'° nnair !. S on . lheir extracurricular activities, their
device required the j lme ’ 3nd the!r P ersona l values. A final assessment
unknowntdlvidual dve"'? ‘° *“*****"* about the behavior of an
bis past behavior* l 1 " cr 5 as,n 8 I y greater amounts of information on
sonal perceptivity, ^ WaS intended as a measure of interper-

ter and^ondnued urndten”' iTho? ‘ he begin " in 8 ° £ the second semcs '
quired abom th r hour sessions had been held, which re-

q about three months. Following the intervention, the test instru-

PREVENTION IN THE COLLEGE COMMUNITY / 211

dents who scored in the upper 30 percent on one anxiety scale, the upper
50 percent on the other, and the upper 75 percent of the aptitude test
This last criterion was employed because of earlier findings that low apti
tude students tended to become marginal performers regardless of anxie

ty

The Duke program was first tested in the 1959 to 1960 academic year
and was partially replicated in the following year In the first year of op
eration the selection criteria identified 112 anxious freshmen, in the sec
ond it identified 124 In both years the eligible freshman received an
invitation early in the first semester to participate in the Academic Orien
tation Program’ or AOP Fifty percent of the students selected in the first
year accepted the invitation and a somewhat higher percentage accepted
the following year The students who thus elected to participate were then
divided into two matched groups of approximately equal size One group
each year was immediately offered the opportunity to participate in is
cussion sessions intended to facilitate adaptation to college i e, t c re
maining students were told that they would have to wait unti t e secon
semester to participate In this way, experimental and control group
were constructed with 26 and 27 students in 1959 to an
students in 1960 to 1961 (there was some attrition from g

cussion groups with six to nine participants rate P j d b „ [he
somewhat larger number in the second year I an[ i a substantial
authors, faculty members with doctorates in P syc 0 , me t for one

amount of experience in group P sy ^“‘ “^number^of Lions in the
and one half hour weekly sessions Th ^ ^ y „ rs differed

first semester groups ranged from 8 to wcre some wliat larger,

as mentioned above in that the second y F P ber 0 f times be

the second year groups also met a slightly greater m
cause of an earlier start in the semester chapter, the group

As with the two programs discusse different students Spielbergcr
miforrnly attended by ditterem „ rord ,ng to

sessions were not uniformly ;
and Weitz divided participants

wii ind low attenders according
•ticipams into hig ^ more sessions or a lesser
whether a student had participated in c performance were an

number Data on scholastic aptitude an a to i960 there were

alyzed with regard to attendance catego attenders low attcn

no significant initial differences ^ %ee " t er showed the high attcn
ders and controls Grades for the rs attenders, however,

ders doing significantly better than t le second >ear partial rep lC3

did least well on first semester reports « bctue en the three categories
tion, there were significant prior i attenders hating the t ap-

of subjects, with the students

uho " ere hl 5 h 2

210 / prevention in the college community

Some prepost change score differences were also detected m compar
mg the two experimental groups In particular, students in the graduate
student led groups tended to show a greater increase in the value that
they attached to status This finding might be interpreted to suggest that
the opportunity to participate in groups led by less familiar, preprofes
sional leaders was apt to be more status enhancing than was participation
in groups with resident advisers as leaders with a concommitant increase
in the value of status by those who had experienced such gains
A final finding of the Wolff study seems to parallel one of the findings
of the Webster and Harris research at MIT The frequency with which
group members sought individual counseling at the student health service
was found to be unusually low As in the MIT study, the possibility is
again raised that freshmen given the opportunity to engage in group dis
cussions with peers in a structured program may be less likely to seek tra
ditional psychological services than would be the case in the absence of
such a program Thus the Wolff study demonstrates that the discussion
group approach can improve the interpersonal relations of male fresh
men and possibly can reduce their demand for more costly types of
services However neither the MIT nor the Rochester program was
found to significantly affect the academic performance of participants
The next program we describe was explicitly designed to improve scho-
lastic functioning as opposed to the interpersonal adjustment goals that
were central to the two programs discussed above

The psychological relevance of a program to improve the academic
performance of college students may be twofold Kysar (1967) has
pointed to the psychological damage that may accrue from the experience
of failing to meet the challenges of scholastic life On the other hand the
occupational skills living skills and confidence that may result from the
students ability to complete his schooling successfully may do much to
prevent the occurrence of later psychosocial failures Cognizant of these
factors Spielberger and Weitz (1964) initiated a program at Duke Uni
versity designed to aid students believed to represent a high risk group
with respect to the possibility of academic failure

Basing their premise on earlier research Spielberger and Weitz be
leved that highly anxious incoming freshmen were likely to experience
considerable difficulty in performing up to their academic potential The
uuke researchers believed that these students might often become college
dropouts or troubled marginal cases Spielberger and Weitz sought there
ore to irect their efforts toward anxious incoming freshmen males se
ected through an exhaustive screening of new students All incoming
male freshmen were required to complete an adapted version of the Min
nesota Multiphasic Personality Inventory scored for two scales of anxie
ty, and a test of scholastic aptitude Eligible for the program were stu

PREVENTION IN THE COLLEGE COMMUNITY / 213

vironment. Finally, these programs did not engage the creative participa-
tion of the population to be served. In some measure, the projects
described repeated the traditional sequence of the professional worker at-
tempting to bring to a community a treatment technique determined by
his own preferences, applying the technique without particular concern
for its impact on the system as a whole, and finding that the cooperation and
response to treatment in the target population are limited.

These three programs should probably be categorized as primary or
secondary prevention. Certainly, the project at Duke, dependent as it was
on early detection has the features of a secondary preventive elTort. Unti
programs of early prevention can be made both effective and readily im
plemented, however, a significant number of college students will contin
ue to experience relatively severe psychosocial crisis during their sc 100 ing.
An innovative program of tertiary prevention was dev elope at an
sas State University for providing services to students w ose pro e
had reached the severe or chronic stage during their co CarCC
nett, Wiesner and Frieser, 1967; Sinnett and Niedenthal, 196«) .

The Kansas State program centered on the fonnatu an of a Mfnay
house for students whose needs were seen to exce t lose . ^ un .

met by the traditional student mental healt sersices counseling

dergraduates were nominated by the personnel o t ic c ' I •

center as being individuals retiring ~ e>P " " ^ ^
ongoing therapy. Sinnett, Wiesner, and Fn L ion as might be found
clientele thus defined was not so deviant a pop hospitals. Even so,

in a halfway house for former patients o sta ^ proR nosis for col-

the disturbed students represented a group ‘ residents of the

lege completion and a fair chance of hospita iia ^ a majority, of
halfway house also included a substantia nu ,' nom j na ,j 0 ns by deans,
"normal" students loosely selected on the professional mental

residence hall directors, and school cmime ^ ^ ahhouR l, they ssere
health workers svere residents in the ' 0 ,„inc basis
available as consultants on both a crisis an re f crra i mechanism indi-

Early experience with the counse tng cc [ K . ; ( lentified as appro

cated that about 50 to 70 students per yea |inm arried full time stu

priate for the project. Of these nominees, ^ p ;nt occupants of tlte

dents ssere generally invited to P' 1 "'"!' , .Hsideil ecpially lieti'tcn
halfway house consisted of 20 disturbed st „,e solunleer . u

males and females, and 10 other residents „ c , al . 1 967 ) A. o 1

dents and some administralisc personnel^ jor.S) . 2’

third semester of operation (Sinn rt j ( j cn ts in the home

referred by the counseling center l3t initially paid 3

The student volunteers in the pr°j ^ •♦ rr mlent fcllo* - * T »»♦ p*
for their participation and gi' cn * 1C

212 / prevention in the college community

titude scores, followed by the controls and, then, the low attenders. In
ranking the groups on first semester grades, the same order was noted;
when initial differences were partialed out, the difference in grades did
not prove significant, although a trend remained. Interview data collected
from the group participants showed that the high attenders regarded the
sessions as having been helpful in developing their approach to studies
and their way of relating to faculty, while the low attenders did not stress
these factors as frequently. Both categories of participants tended to re-
port that the most helpful aspect of the experience was the chance to see
that they were not unique in their anxiety over scholastic performance.

Because of the ultimate interest of the authors in the program as a
method for reducing academic failures and dropouts, the freshmen sub-
jects were followed through their first and second college years. The high
attenders were found to have the lowest rate of academic failure, fol-
lowed by the low attenders and the controls, but these differences were
not significant. Moreover, all three groups had low rates of academic fail-
ure, raising the question as to whether the selection procedures had been
adequate for identifying students who would be likely to end their college
careers prematurely. In comparing all of the students who had been iden-
tified as anxious, however, it was found that they did drop out more fre-
quently than less anxious students. Unfortunately, the greatest number of
severe underachievers was found among the anxious students who had
never volunteered for the program. Once again, empirical support for
voluntary group discussion programs was demonstrated, but it was also
shown that such a program may not reach the very students who most
need the help. Commenting on this possibility, Spielberger and Weitz
concluded that a substantial need may exist for programs that more effec-
tively reach out to the student population, perhaps through consultation

Wlt . C °. ege P ersonne l who habitually come in contact with students ex-
periencing difficulty.

. The P rograms at MIT * Rochester, and Duke are all illustrations of one
innovative principle that may deserve wider deployment: all of these pro-
jec s reac e out to their clients. The need to abandon the passive stance
typical of traditional mental health programs may be a major considera-
. formulat . ion of new and better campus interventions (Falk,
r __V et ' 11 1S St i ri J tmg that a11 three projects failed, at least partially, to
W and help the needful members of the community. Conceiv-
intJrv 1 r ght bG explamed by weaknesses in the technology of the
: A Careful conside ration of the programs in toto, however,
cited ° ^° int t0 a d ‘^ erent level of assessment. None of the programs
r a PP ear to have rested on a prior analysis of the particular features
rf«TJ am ? U5 rammunity in which the y were to operate. In none did the
action involve a flexible strategy to alter broadly the student’s en-

PREVENTION IN THE COLLEGE COMMUNITY / 213

vironment. Finally, these programs did not engage the creative participa-
tion of the population to be served. In some measure, the projects
described repeated the traditional sequence of the professional worker at-
tempting to bring to a community a treatment technique determine y
his own preferences, applying the technique without particu ar concern
for its impact on the system as a whole, and finding that the coopera ion a
response to treatment in the target population are hmite .

These three programs should probably be categorize as p i
secondary prevention. Certainly, the project at Du e, epen
on early detection has the features of a secondary prcven iv .

programs of early prevention can be

plemented, however, a significant number J'^during their schooling.

ue to experience relatively severe psychosocic developed at Kan-

An innovative program of tertiary problems

sas State University for providing services college careers (Si-

had reached the severe or chronic stage uri g 1968).

neft, Wiesner and Frieser, 1967; Sinnett an »e Q f a halfway

The Kansas State program centere on ^ t h 0S e that cou ld be
house for students whose needs were s fy n serv ices. The troubled un-
met by the traditional student menta ea t h c campus counseling

dergraduates were nominated by the P^ 0 ". he j p j n addition to their
center as being individuals requiring ex _ e i\%1) comment that the
ongoing therapy. Sinnett, Wiesner, an ] at ; on as might be found

clientele thus defined was not so devia xnental hospitals. Even so,

in a halfway house for former patients o ^ a poor prognosis for co
the disturbed students represented a f ? lizat j on . The residents of the
lege completion and a fair chance o num ber, in fact, a majority, o

halfway house also included a su j| stan ‘ basis D f nominations by deans
“normal" students loosely selected on * e No professional mental

residence hall directors, and school , 10U5( ., although they «c

health workers were residents in routine basis.

available as consultants on bot a cen ter referral mcciams

Early experience with the w0 uld be identified W

cated that about 50 to the

halfway house consisted of 20 d.^ ^ including ,h J Aj of

males and females, and onn eI < s,n " ct, t *', ,'w,S). 28 students

-

for their participation anil pven the

212 / prevention in the college community

titude scores, followed by the controls and, then, the low attenders. In
ranking the groups on first semester grades, the same order was noted;
when initial differences were partialed out, the difference in grades did
not prove significant, although a trend remained. Interview data collected
from the group participants showed that the high attenders regarded the
sessions as having been helpful in developing their approach to studies
and their way of relating to faculty, while the low attenders did not stress
these factors as frequently. Both categories of participants tended to re-
port that the most helpful aspect of the experience was the chance to see
that they were not unique in their anxiety over scholastic performance.

Because of the ultimate interest of the authors in the program as a
method for reducing academic failures and dropouts, the freshmen sub-
jects were followed through their first and second college years. The high
attenders were found to have the lowest rate of academic failure, fol-
lowed by the low attenders and the controls, but these differences were
not significant. Moreover, all three groups had low rates of academic fail-
ure, raising the question as to whether the selection procedures had been
adequate for identifying students who would be likely to end their college
careers prematurely. In comparing all of the students who had been iden-
tified as anxious, however, it was found that they did drop out more fre-
quently than less anxious students. Unfortunately, the greatest number of
severe underachievers was found among the anxious students who had
never volunteered for the program. Once again, empirical support for
vo untary group discussion programs was demonstrated, but it was also
shown that such a program may not reach the very students who most
need the help. Commenting on this possibility. Spielberger and Weitz
concluded that a substantial need may exist for programs that more effec-
tve y reach out to the student population, perhaps through consultation
with college personnel who habitually come in contact with students ex-
periencing difficulty.

The programs at MIT, Rochester, and Duke are all illustrations of one
innovative principle that may deserve wider deployment: all of these pro-

!vnT/r C f ^ U - t0 theiF Clients ' The need to abandon the passive stance
typical of traditional mental health programs may be a major considera-

iSmV? f °! rmul . at . i0n of new and better campus interventions (Falk,
rearh A et> U 1S S ^ 1 J U ! lg that a11 three P r °jects failed, at least partially, to
ahlv ’.V g t ge ’ an l h l lp thG need£ul members of the community. Conceiv-
interv^r!,' 3Ct ” llght be ex Pained by weaknesses in the technology of the
10n .' car eful consideration of the programs in toto, however,
cited a ° P ° mt t0 a different level of assessment. None of the programs
of tf>A Pp€ar to ^ ave reste d on a prior analysis of the particular features

i am P us community in which they were to operate. In none did the

P action involve a flexible strategy to alter broadly the student’s en-

PREVENTION IN THE COLLEGE COMMUNITY / 215

The Kansas State project may be viewed as an effort to create a thera
peutic community within the larger community of the university This il
lustrative program naturally raises an important question Is it possible to
create a therapeutic milieu that encompasses the entire campus by alter
ing crucial features of the total institution? If such an approach were fea
sible, the potential advantages would be substantial In particular, a total
community approach would be more apt to reach needful students,
whereas it has been shown that more limited interventions may fail to in
elude students whose needs are great but whose motivation to participate
is low Furthermore, a project aimed at substantially altering the college
experience by redesigning aspects of the institution wou capa e o
serving as true primary prevention Several programs are now es °' 1 _
that illustrate the kinds o£ efforts that have been made to study and alter
relevant features o£ the campus operation ,n the interests of preventive

''''RetfleT Lipz.n, and Fox (1967) engaged m a program of. hnuted
scope that still managed to produce an risem “ J ^ ^

operation They studied the rate : of p Y nonr< ,f lden , students, espe
University o£ North Carolina and to ^ a r£Sul[ of , heir finding

cially freshmen, tended to seek more was esU bhshed requir

being reported to the school outcome may have been do-
ing that all freshmen live on campu ( whlc h the consultants

which the consultants

sirable but probably did not increase
were held among the students ) m tv approach was reported

An earlier effort to employ a total men tal health

by Levendge in 1957 As m ‘ ^scholastic institution and to provide
consultants attempted to study ,mnro\e the milieu psychologi

suggestions as to changes that wou 1 wo types of features of God
cally Leveridge and his associates s pjrst, the researchers studied

dard College, a small college in c hac wounds needs values and the
the students of the institution D 8 t ruments to determine the

like Second, they employed F^ e “ d ent population Based on their

patterns of group influence wit n «i feedback to faculty an a mm

findings the mental health team P«»' d “ mbcr5 „ c re solicited as panic,
istrators, at the same time ihese “ The Goddard project was
pants in further efforts to «udy «' e «n-P sctIing could be a lafr

.mended primarily to demonsun.e to. ■ ^ ^ Iask of res.r, . curing

oratory for applying .he behavioral No data were reporieil to md.cale

all change in the adjustment of Ooo

214 / prevention in the college community

tice was discontinued when it was found to produce jealousy and to in
crease social distance between the disturbed students and the volunteers
The actual living experience tended to blur the status distinctions One
volunteer commented as follows

“Perhaps the distinction between clients and volunteers has appeared
to be quite precise However , in actual living within the project, this is
not the case Each individual is aware of his own position, but is not nec
essanly aware of each other person’s designation While thts is sometimes
relatively apparent, at other times there is no obvious behavioral distinc
tion between the two categories A volunteer is not always a helper nor is
a client consistently receiving help There is no real status difference m
functioning either as a client or as a volunteer Each person is aware that
at times he has problems, some of which he can handle more effectively
than others Likewise, some individuals can consistently handle situations
more effectively than other students can However, both of these state
ments refer to any individual in the project, not to persons in one group
or the other ” (Sinnett and Niedenthal, 1968, p 237)

In addition to the usual features of college dormitory living, the half
way house offered a number of special activities The residents met peri
odically in planned group sessions, ad hoc meetings were held, and con
sultations with project consultants were available The counseling service
clients in the house also continued to receive their individual psychother
apy (Sinnett et al , 1967) The in house activities were said to emphasize
the value of communicating feelings as a means toward exposing and re
solving interpersonal conflicts

Early data from the program were found to be encouraging In the first
semester of the halfway house s operation none of the resident clients left
the school Findings reported after three semesters of operation (Sinnett
and Niedenthal 1968) showed that 6 of 28 clients had left the college a
rate that was considered relatively low but that was not significantly lower
t an the rate for controls who had been referred and were not admitted
to the halfway house All students in the project were asked to rank the
— ex P^ nences associated with program participation according to
heir helpfulness Both clients and volunteers tended to agree that the in
orma contacts with other students engendered by the living arrange
ments were among the most useful aspects of the experience Thus the
oasic tact of bringing the two types of students into a situation where they
ig it interact was found to have been a highly positive element in the
p ogram as judged from subjective reports It should be mentioned that
presume fate of many of the client residents would have involved
i e t e opposite experience, that is extrusion from the community of
ampus peers into the outside world or die world of the mental hospital

PREVENTION IN THE COLLECE COMMUNITY / 217

In the category of tertiary prevention, the program included facilities
for several modes of treatment, including group psychotherapy, individu
al therapy, psychodrama, chemotherapy, and crisis hospitalization A
specifically preventive feature of these services was that they were of
fered on a no waiting basis Students seeking help were immediately seen
by the psychiatric nurse for screening, the nurse then recommended a
course of treatment or referred the client on for further evaluation It was

found that about 33 percent of the students entering the screening proce
dure required significant amounts of treatment, while about 60 percent
needed to be seen only briefly (Barger et al, 1966)

Multifaceted interventions such as the program at the University of
Florida certainly seem to represent promising actualizations of many
principles of community mental health These programs o, °^ ever '
face a number of problems As Bngante (1965) has noted, members o
the academic community may not universally we come menta
programs, and efforts requiring widespread participation y r .

are ltkely to meet considerable opposition Anot ter pro e
fact that the effectiveness of programs aimed at s.gntfican y alt ng ^
campus environment ts more d.fficult to demonstrate than ts he case m

smaller programs having narrower goals ns a er respect

lem both w.Th respect to • sel.tng • the m.erventton and also, with respect

to making refinements based on the ass “ S T C r n demons £ a nng community
potential value of major campus progr further ef

mental health prtnc.ples and for serving people would jus

forts to develop programs of this fund slands out as one of the

The project at the University of ^ a true community inter

best examples of an effort to devel p « P an d i ns associates made
vention strategy in a university settl "^ . , ' ten stics of the community

definite attempts to analyze the speci _ ctlons and to involve large

to select the best places to focus interven ^ ^ n0t clear, however, that

segments of the community in the at t j, e level of planning or

the project solicited much student par 1 P ^ co n ec ted through the re
service delivery There was stud ent mp campus communit) the

search efforts, but of the various segme t j JC operation of the ncv\

students apparently pH>ed the sun “ programs hive appeared in rc
services In contrast, a number o , b%°studcnts

cent years tint are primarily or so e ^ j somc but not all arc

Of the student staffed sen.ee health fact.,., A. s

Of the student staffed health facility Al : »

incorporated into a profess, Dually man S u ^ ^ !tud) po „p policy
convention of counseling center t ‘ otess ,onaIs in their opera' 10 "’

135 directors about the use of par- P sunc> c0 percent reported th
the G3 directors who responded to ^ o( ,j, c ,r efforts (Crane a

they use undergraduate help ,n «™ e P j n some ms, antes tlte student
Anderson cited in Stcenland )

216 / prevention tn the college community

made with the period of the study and consultation, it would ha\e been
virtually impossible to prove that factors other than the program (such as
cultural shifts in student values) could not account for the observed
changes

The final program considered m this chapter represents the most di
verse and ambitious effort to introduce public mental health principles
on a college campus The mental health program at the University of
Florida (Barger, 1963, Barger, Larson, and Hall, 1966) was designed to
meet the goals of primary, secondary, and tertiary prevention by ap
proaches that would not overtax manpower resources As of the 1966
report the staff of the program consisted of three psychiatrists, three psy
chologists, one psychiatric nurse, clerical assistants, and graduate stu
dents in training

In the interests of primary prevention, research was conducted to de
termine the sources of environmental stress that confronted the student
( arger 1963) One study focused on the degree of congruence between
the values and attitudes of students and the normative goals of the mstitu
ion, it was hypothesized that low congruence would be a source of stress
not ler study plotted the help seeking efforts of students over the school
year to it enti y the particular scholastic activities that contributed to the
uildup of tension among students or served to release tension Findings
this research revealed that such things as difficult courses became a
° f StUdCnt dlStress around the examination periods On the
be com-/ 1 * °PP ortunities to participate in athletic events were found to

d Znt u/ hird StUdy W3S desi & ned to identify background

life aMhe lln y i es assoc,ated ™ h the ability to adapt to student

in Dro 2 Tams n 7 erSUy lndm S s trom these research projects were utilized
" e f e X 21 l ° nSUl T° n W “ h facult y and administrators Some con
cludme rnfor ** attnbuted to th e work of the mental health team, in
“ the heShmen o^ntanon program and the mtro

their Barents “V ^ uest ‘onna.res by which incoming students and

legf^et aU966) V,de ,nf0rmat,On the ““ d “‘ s

the early identifi™?' 1011 edorts £ocus od on the development of means for
ance Toward tl,™ '°!i ^ treatment o£ students' psychological disturb
show students were given MMPI's an! individuals
About 10 percent ofthe ° ffered opportunities for counseling

the test but mi 1 1 v unarming students were found to be deviant on
other m^ or as ' y c. 0n „f ttf ° £ a ^P" d ** offer of treatment An
tabhshment of^nm * secondary preventton program involved the es

ceners,” suc h ^ P“> and «

in a position tn y , embers and residence hall personnel, who were
1963) S ^ 0t * G ear * y S1 gna!s of disturbed behavior (Barger,

PREVENTION IN THE COLLEGE COMMUNITY / 219

T able 1 Sex and Educational Status of 246 Callers

(Tucker et al , 1970, p 345)

Group

Female

Male

Total

College student
Unknown

High school student
Nonstudent
Junior high student
Total

N

Percent

142

55

10i

45

246

100

89

56

57

26

48

19

44

16

8

5

246

100

population exclusively although the student callers . serv

est group of users Telephone hotlines cannot feasi y rcs 1 a!sure t p, e

ices to members of a par, icu.ar community gwe

hZ^r^:“th^ or »

was also subject to a fairly high percentage of m S rcscnt t h e

swcr calls (ibout 37 percent)

data collected for the first three academ q r „ ntlon the sen ice pro-
tionmg These data indicate that, eve " of » tong given to the stu

vided a substantial amount of aid, with much ot it tong b

dents of the college

Table 2

Dating
Family
Loneliness
Pregnancy
Classes
Finances
Marriage
Drugs
Alcohol
Other
Total

Problem Areas Mentioned by 183 Callers

(Tucker et al , 1570, p 315)

218 / prevention m the college community

workers were said to be serving m clerical positions or as written test ad
mmistrators More than 40 percent of the student staffed projects, how
ever, involved hotlines or drop in centers and peer counseling Thus pro-
fessionally run campus counseling centers have, with some frequency,
sought to use undergraduates as a source of direct aid to their peers
There are still other operations similar m purpose and approach, that
were started by students and that remain separate from other existing
mental health facilities on campus A few of these true “grassroots” ef
forts have been instigated by and for special interest groups in the college
community, for example, homosexuals The majority of student run pro
grams probably do not differ radically from the professionally managed
programs in their areas of concern There may, even so, be an important
philosophical difference

Whereas professionally instigated programs using undergraduates as
e ping agents generally are conceived as mental health test projects, the
student initiated programs are often oriented almost totally toward serv
ice Not surprisingly, therefore, it is relatively hard to find published re
mrr°iV ^ ° r im P act °* student run programs Some evidence

° S 5 y ' ) suggests that programs of this type may rapidly be

me professionalized or cease to function What is central to many stu
vent mn 1 r: P r °J ects 15 not a c °ncept of community mental health inter
useful" U * rat ^ 3 ^ umanistlc philosophy and a zeal to be humanly

studentelw hri« CXample ° f ^ P rofessionall y organized project utilizing
Center fo,m 1 iT" 8 e 86 ”? m their OWn commun »ty is the Campus Crisis

s,ate co,,ege in ,958 (Tu r

mmnr 8 ’ cnsis center was founded to serve three

anonvmmi 9 A * '° supp ement ‘"adequate counseling services, to permit
rtr p r„“ n embarra “’ n S problems, and S ,o bring help closer
line was mnl ° lven th «e aims the strategy of a telephone hot

among the faculiv Y°’ unteers to s ‘aff the hotline were sought from
body Undenrrad Y T * ™ nistratIon o£ t£ >e college as well as the student

tion lectures" hsten reCei , Ve;1 24 / lours o£ ‘raining which involved onenta
Once on the ioh "It? n U , Ped telephone conversations, and role playing
could be consultants * ^ jj 6 helpers had access to professionals who

felt his skills wool I ° f C °tt d take ° Ver on occas ‘ ons when the volunteer
‘beets on each ^ 2 ‘”«™ted to keep work

ly meetings were !■ in essentla£ £acts about the interaction Month

eration of the hotline *° ' SCUSS prob!ems and wa y‘ ° £ improving the op-

As is shown in Table 1 the campus hotline did not serve the campus

PREVENTION IN THE COLLECE COMMUNITY / 221

imposed on mental health professionals would be inimical to the creation
of effective outreach efforts, but did not interfere with the work of the
student run hotline

As m the Colorado State project, hotline personnel attempted to re
cord relevant information about the calls received The problem areas
mentioned by some of the early users of the service are shown in Table 3
As was true at Colorado State, problems in social relationships were
common, but the American University hotline serviced more drug prob
lems and several calls were classified as information seeking instead of
help seeking Whether these differences reflect variations in the expressed
purpose of the two operations the populations they served, or the system
for recording the nature of the calls is difficult to say It is again obvious
that the hotline provided aid in a variety of situations and could not be
aptly regarded as a suicide prevention agency

It ,S evident that the evaluate of hotline effeemenes. po.es spec, a
problems Campus hotlines like those described o er to t ten ’ u ' ’

one of their attractions, the opportunity to remain a ” 0n>1 "°'' .

reports on the outcome of the inte.vent.on are available only is hem the
user chooses to provide such feedback, and 1 lose lv 10 d lny

overrepresentation of satisfied users Thus few T ,

direct evidence of their impact on the campus “m-n mity A study o
evaluate hotline services by an indirect means . w. conduced ,n .
Washington, D C area (Bleach _and Cla, botr In non

Four hotlines sen.ng college®- ' h'gh oo. ^ a|ong !C ieral d,

professional volunteers of similar ag

Table 3 Breakdown of Problem Areas Mentioned
by 59 Callers (McCarthy and Berman
1971, p 527)

Drugs

Dating

Emotional*

Lonel)

Legal

Sex

Academic
Peer
Suicide
Ollier
Information
PranL

220 / prevention in the college community

On their worksheets the volunteers attempted to record the problem
areas mentioned by their callers. Table 2 shows the types of problems
brought to the volunteers by some of the callers who used the service in
the first three semesters. As may be seen, the most frequently mentioned
problems were those related to social relationships or the lack thereof. In-
terestingly, none of the calls were classified as involving threats of sui-
cide. This is notable, because the pioneer work in the area of nonprofes-
sionally staffed hotlines was framed in the context of suicide prevention
(Helig, Farberow, Litman, and Shneidman, 1968) . Clearly, the useful-
ness of the service extended by the Colorado State program was in other
areas, many of which closely parallel the types of complaints that bring
clients into face-to-face counseling situations. The concept of crisis inter-
vention does not, however, involve the notion of long-term efforts to cor-
rect chronic adjustment problems.

At American University in Washington, D. C., a structurally similar
hotline operation was started through the instigative efforts of a small
group of students (McCarthy and Berman, 1971) . These students sought
out professional guidance in their efforts, but remained the primary or-
ganizers. They originally conceived of their hotline as a referral service
t at would inform callers of helping agencies on or near the campus. The
concept also came to include direct service to callers in crisis. A multidis-
cip inary board of advisers (including lawyers, psychologists, and ob-
stretricians) was recruited by the student founders. Berman and Mc-
Carthy, who reported the program, were given the responsibility for
raming t e volunteers. Thus professional advice and training was uti-
lized, but the program remained essentially in the hands of the students.

ie student government financed operation of the crisis center.

A core of hotline workers was selected from among the students in a

niversity course on crisis intervention. Enrollees in the course were
carefully screened for emotional stability, integrity, and receptivity to
. °y e i w ” rkers in the project received about 30 hours of training,
which included didactic presentations, discussions, and role playing. The

unteers ^ trained in tIlis wa 7 ^ ater served as trainers for new vol-

niph^n” 6 j CS were manne d from late afternoon and through the
PuhliVit" f ^ u 3yS ’ ° n weeken< ^ s t ^ le service functioned continuously-
news™™-!- 01 , 1 6 f ervice originally took the form of posters on campus,
seeZl^ k Ve ^ 1SementS ’ 3nd CalHn S cards - When methods of this sort
was crp-n^ r aC lievi ӣ ^ ess dian optimal visibility for the program, a film
iH, m , ° r S 10 y in g at appropriate campus gatherings to explain and
this tvnp • C S * uncdon * 11 should be noted that publicity efforts of

sionaU^ * «*!? ** r . e ? arded as ethical ly questionable in the case of profes-
y tailed traditional mental health facilities. Such ethical constraint

PREVENTION IN THE COLLEGE COMMUNITY / 223

This chapter would not be complete without mentioning the ways m
which some campuses are changing in fundamental ways in response to stu
dent pressures for an improved psychological milieu A prominent move
in this direction is the establishment of coed dormitories with relatively
relaxed rules about heterosexual intermingling This experiment in mak
ing the college community more nearly resemble the community at large
may be as important for the philosophical changes it reflects as for the
immediate effects on student mental health In the introductory portion
of this chapter we mention that a source of stress for college stu ents is
the ambiguity of their status, they are neither given full adult privileges
nor the right to be as irresponsible as children American co ege a min
istrators have typically operated on the assumption that t e sta in
college community must function as surrogate parents to t eir stu en
The establishment of coed dormitories, which challenge the student to
make more of his own decisions regarding sex an 1 e s y e,
a philosophical shift toward viewing the student as an a : u w ^ ^
should be allowed to make lus own mistakes ns s 11
curring on campuses where ^ -I J-^^idTpr^
abandoned or substantially altered In the prelum

(Barger, ,963) previously described, «

nary research was the fact that anxie y aTTinnf r the college pop

threat of poor grades were major sources o^ competl t 1 ve grad

uation The alteration or abandonme , mporta nt instances of a

ing systems may, therefore, prove ^ a]though this innovation may also
stress reducing environmental change ( S

have its drawbacks) , _ f ^ rtr , rs suc h as grades and

Changes m institutional policies expressIO ns of student dis

living arrangements often have resu protest action (Feldman,

satisfaction or even from instances o ^ conirn unity psychologist

1972) It would be incorrect to SU PP““ tIon of camp us experiments
has thus far played a major role in me i B ^ rtumt y clearly ex
favored by activist students Despite t is j S( have an impact on

ists for the behavioral scientist to study a . ^ wlth other programs

student initiated programs of campus cip j es of community men

discussed in this book, efforts to implement p j> — ■ *•” "™-

discussed in this book, efforts to implemen P instigated by the P r °"

tal health need not always be rcs.nc.cd o proie®^^ ^ ^ fie]d

fessional worker Indeed pessimists in tn from outslde a com

have been known to argue that d ' an f e efs the professional can often
mumty may be a near impossibi lty, ' ntane ous movements « n

have influence where he capitalizes on . ef f orc e for change from u i
the community and joins to become

in .nnovamc alterations of the

A final comment is warranted concern g

222 / prevention in the college community

mensions. Data were collected by having experimenters call the services
purporting to be experiencing difficulties in one o£ four areas: possible
pregnancy, loneliness, parent conflicts, or drug related problems. Calls to
the hotlines were rehearsed to assure uniformity. Hotline workers were
advised that the experimental calls were to be made, but were not given
information that would enable them to identify the simulated requests for
help. In total, 96 calls were made to the hotlines, with each service re-
ceiving 6 calls of each type.

The experimental calls to the hotlines were recorded so as to facilitate
evaluation. Responses by hotline workers were scored on several scales
aimed at rating the amount of information provided, the style of informa-
tion giving and the interpersonal skills of the volunteer. Results of the
study indicated that the four hotlines differed significantly in the effec-
tiveness of their interventions. In addition, some differences were found
to be related to the type of problem posed by the caller. Of particular
relevance to this chapter's discussion is the finding that the hotline which
showed generally superior performance was the one that was staffed ex-
clusively by college students. This service was also known to be unique in
the intensity of its screening and training procedures. Bleach and Clai-
born (1974, In press) did not offer validity data to verify a relationship
between the measures used and the actual effectiveness of the hotline in-
terventions. However, some of the scales used had been related to coun-
selor effectiveness in earlier studies of other types of therapeutic inter-
ventions. It is not farfetched, therefore, to conclude tentatively that the
research provided indirect evidence for the effectiveness of a well-
planned, college-centered, and student-staffed hotline.

To an extent, the campus telephone crisis centers illustrate the princi-
ples underlying projects described earlier in the chapter. In particular,
t ey represent another approach toward reaching out into the college
community to provide services to those who might be reluctant to come
to a traditional mental health facility. In some respects the student-run
centers illustrate an approach not seen in other programs. First, they tap
the creative abilities and helping skills of the very population that the
services are intended to serve. Second, they may serve the worker stu-
dents themselves by providing them with an opportunity to provide their
peers with a psychologically useful service. Finally, these programs may
spea rat er directly to the problem of sensed alienation among college
• U T 6I !. tS y providing a source of aid that may be viewed as less threaten-
mg y establishmentarian” than existing mental health programs. In this
aspect, the campus crisis intervention projects may have a general
impact on the college milieu. Yet, realistically, the existence of a number
ca on campus for nonprofessional help can hardly be assumed to con-
t ute a ra ical alteration of the campus as a living environment.

cosaxsiov I 225

the newness of their effort to reach out into the community to provide
service. In reaching out, such efforts inevitably functioned to change sub-
tly one basic aspect of the campus environment; they made students
aware of an active concern for their human functioning. These narrow
programs did not, however, prove highly effective even within their areas

of primary concern.

Subsequent to the description of programs utilizing a small set of tech-
niques to reach out to the campus community, we discuss several pro-
grams that exemplify a broader effort to understand and to alter the
social milieu of the campus. The program at the University of Florida is cit-
ed as a particularly striking example of an effort that was keyed to the
characteristics of the particular community and was acme!) responsne
on a broad range of fronts. The ultimate worth of these "total communi-
ty” approaches is, however, considered to be lacking in empirica suppor
because of the problems of assessing multifaceted, broat goa ct projee
A characteristic shared by both the broader and narrower
the general lack of input from the segment of t ic communi
seen as the target of the intervention, the student ^yT , C oc , hc
concluding program examples are projects fa. were amq«' m f ctr a.
tempts to utilize students as resources, on the r0 " ‘j pr0 -, T a m i

even at the project roots as initiators and adm.m at^ These prtrgr. ^

were committed in varying cx,ent * '°" e “ lively primitive in mou

the student population. They arc fotm am , c ‘.,|„„i 0 n. Never-

cases with respect to sophistication of . are v ictvc<! as con-

theless, the student-run or student-initiatcc j ‘ p segment*

tributing the possibly vital concept of the voces to msohe
of the community in the process of communi > failures of program*

In general, the concepts, methocls sxiccosso ^ ons f or community
in the colleges seem to have cnoug program* de*rril*d

chologists to justify continued inno\ame c ^ j„ p r «\iding mcftil

here, many of which were less than *' i° - vc KOrt |, ilicir rmt for
human services, may nonetheless C'^ntu ^ theory and praciuc of
the understandings they may contH > u howocr. if experiment*

community psycliology. This will > providing enough <bu m

lion and innovation continue, thus — »h it facd

lion and innovation continue, thus f'f” 1 ”’ »* ^jfic uratrgir* that taci\
allow us to discern the general princip * } ttfT j lt ics

in communities of 1

itatc interventions

224 / prevention in the college community

college community. To this point, nothing has been said of efforts actual-
ly to create new institutions of higher learning to serve better the human
needs of community members. Such efforts are not unknown, although
they face great obstacles and have often been doomed to failure (Wolfe,
1970) . One of the newer developments on this front has been the emer-
gence of the "free university” as an entity within or without the settings
of established collegiate institutions. One model for such innovative edu-
cational establishments has been provided by the example at Berkeley,
where students dissatisfied with the standard curriculum initiated the de-
velopment of a set of courses markedly different from the usual Universi-
ty offerings, including, for example, "Theory and Practice of Medita-
tion (Bilorusky, 1972) . While few if any of the free university programs
seem at present to offer a full and independent alternative to existing in-
stitutions, they do point toward a model for student-structured college
communities that might be founded, given the necessary resources and
sufficient interest on the part of potential enrollees. It remains to be seen,
however, whether such radical innovation is truly necessary or if current
academic communities can change to become more broadly responsive to
their members wants and needs, thus obviating the reason for the estab-
lishment of totally new learning environments.

CONCLUSION

The college community represents an obvious and logical choice for the
trial of programs of innovative mental health service delivery. The need
for service is evident, and existing models may be inadequate. The com-
munity offers the human resources and ecological characteristics to make
possible the establishment and study of new environmental features. Fi-
nally the campus offers a community that the mental health professional
a ready understands to some degree and, thus, one where he need not
start from scratch in conceptualizing the needs and possibilities for
ange in the setting. Despite these reasons for selecting the college com-
munity as the locus for intervention, actual efforts to intervene have been
• ^ ^ rare ‘ e difficulties of working within one’s own system may

• account or this fact. Perhaps another reason may be the general
I . a i P res ^ u * e or professionals to redirect their efforts away from the
ward^h y f nV ! members of society, such as college students, and to-
ward the troubled and "troublesome” poor .

to rl^fr^ r °^ amS ^* scusset * * n this chapter spanned a wide range with regard
eram ^ ( .° f innovativeness and extent of intended impact. Initially, pro-
srrih re atlve y narrow focus and fairly traditional techniques are de-
lese programs derived their innovative quality primarily from

Rxrrwscrj / 227

tion living unit for disturbed college students Community Mental Health
Journal, 1968, 4, 232-244

Sinnett, E R , Weisner, E F , 8. Freiser, W S Dormitory Inlf v*ay house
Rehabilitation Record, 1967, 8, 34-37

Spielberger, C, 8L Weitz, H Improving the academic performance of anxious
college freshmen A group counseling approach to presentioti of
underachievement Psychological Bulletin Monographs (whole, no 590).
1964, 78 , 20 pp

Steenland, R Paraprofessiomls m counseling centers Personnel and Guidance
Journal, 1973,57,417-418

Tucker, B J, Megemty, D, 8. Vigil, L Anatomy of a campus enm center
Personnel and Guidance Journal, 1970, 48, 343-318

Webster, T , &. Hams, H Modified group psychotherapy, an experiment in group
psychodymmics for college freshmen Group Psychotherapy, 1958, II,
283-298

Wolfe, A The experimental college noble contradiction Change, 1970, ., .6-3-

Wolff, T Community mental health on campus Evaluating group discussions !e«l
by dormitory advisors and graduate students Unpubln i ‘ octora
sertation, University of Rochester, 1969

226 / prevention tn the college community

Barger, B , Larson, E A , 8. Hall, E Preventive action m college mental health
Journal of the American College Health Association, 1965, 15, 80-93

Bilorusky, J A Selection of student initiated courses Student autonomy and
curricular innovation In K A Feldman (Ed), College and student selected
readings in the social psychology of higher education New York Pergimon
Press, 1972 Pp 453-462

Bleach, G , &. Claibom, W L Initial evaluation of hotline telephone crisis
centers Community Mental Health Journal, 1974 In press

Bngante, T Opportunities for community mental health training within the
resident! 31 college campus context Community Mental Health Journal, 1965,
I, 55-61

Falk 45M55 lnn ° Vatlons m “liege mental health Mental Hygiene, 1971, 55,

Farnsworth, D L Psychiatry, education, and the young adult Springfield, 111
Charles C Thomas, 1966 p 6

Feldman, K A Recommendations, innovations, experimentations and reform In
hnrhnl e ma / n i, ^ ’ Co ^ e S e and student selected readings m the social
435-442®’ ° h ' Sher ed ' lmUon New York Pergamon Press, 1972 Pp

nonprole Jio r naT°v 1 N L ’ L “ man ' R E • 61 Shneidman, E S The role of
Mental Health Journalling' 287-295^ prevent,on “ nter Community

^XLiogisS:?^”"' 5 ° n n,cn,ai hea,ih Amman

''fraLworkc'ommnTrMenwSenM ^ eal,h an al,em P' at a conceptual
Kv „ r r r _ tnty mental Health Journal, 1965, /, 301-308

Health ;ourna""l966 P 2, C 27-34 ° n C °“ eSC Campus Commumt y Mcntal

Lare p"rad.gl'for ar c S 0 ^ D i' h f n Caht '' ,n S N College mental health programs A
l Mental Health Journal, mema ' hea " h CenteK Commm “ y

thebehaviora' saeni^Grou* oratory lor apply, ng findings and methods of
McCarthy B W L Z IT '»■ 10, 64-70

Guidance JournaCim , «,^23-528 denta,Pera ' Cd Personnel a " d

Specter & W ™ telephoning counseling In G A

Publications 1975 It-os ), Crisis intervention New York Behavioral

Commun,,, p^™aIry m i97o!2)' 3^-389 *' “"'S' ran>pUS Hosp ' taI “ mi

Reifler, C B , Lipzm, M B , & Fox T T r* n

psychiatry Amrnrnr, i , ‘ ^ 1 Lol,e g e psychiatry as public health

Sinnett E Uv ' °’ W.f/y, 662^71

R «. Niedenthal, L The use of indigenous volunteers in a rehab.hla

THE SETTLEMENT HOUSE MOVEMENT / 229

sive habits’ and accept work willingly Early m the Salvation Army’s his
tory it was envisioned that once an individual acquired work skills and
proper attitudes, he would be given a portion of land to work This plan
was actually put into practice in the United States where, by the begin
ning of the 20th century, colonies existed in California, Colorada, and
Ohio involving approximately 200 workers Perhaps better known is the
work of the Salvation Army in developing residences, schools, orphan
ages, employment bureaus, legal aid societies, life insurance companies,
day nurseries, halfway houses for prisoners, a youth corps, and a number
of other services for the urban poor Thus the Salvation Army is a rare
example of a community program established many years ago t lat exists
even to the present day

THE SETTLEMENT HOUSE MOVEMENT

Levine and Levine (1970) have described the many

ment, involving a variety of community programs, ia PP

large urban areas during the late 19th and early 20th centuries Tim was

a period when the United States " as "“™" g th ' o a se on the eastern sea
grants who settled in urban areas, part y derable lgno rance

board where most lived in hardship P“ V "^ |ndustm l resolution taking
of the new society that they had entere soc]a] and promp ,

place at the time created further chang w hose important

ed the need for community agencies to s

needs went unmet by the established soc ‘ ely , m respon se to the prob-
Settlement houses first appeared in ng t j, cre The English

lems created by the industrial revo utl0n f ° .j ie ^orj^mg man Idealistic
programs focused on providing education o > come into working class

intellectuals from the universities wou P forerunners of unnersit)

neighborhoods to teach in programs t'a's rauo „ programs concern

extension courses As an outgrowth i n „ 0 f die general life and prob-
developed for gaining a better understan i “ nderstandl „g lt was thought
lems of the working class To aclites nclE hborhood» and to cxperi
necessary actually to live in wor ingc settlement mosement prog

ence day to-day life there Thus the Eng ^ ( a |lcwate a broad

ressed from a concern with education ]n Eng Iand the British

range of the problems besetting the •<»' from tbc settlement home

Labor Party recencd considerable t f* juch as Clement Alice an

moiement, since some of its leading B in| „ polma with an e)C
Stafford Cnpps moved from the m °' ». tica i action
solung social problems through j 3 ro Ie in the carl> cin

In the United States the church ph><*

9- prevention programs in
the greater community

Sc.fic 0 r n amS de$Cnbed U P to thls P omt have been earned out within
r iT, mU T ty as r naes ’ P"> r >V Sch ° 01 systems These agenc.es
lari concern f /° r P reventlon programs, since they bring together
hshiem of ™ P “ ple StnVmg toward a common end The estab

probablv h P e ^ ntlon programs for adults in the community at large has
natural ii? n s, ,rr red ty U,e £aH ' 1,at lhere •» relatively few such
grams and the f ’ ‘ iCVCI;l1 recem examples of community pro

Levine 09701 aSC1 " atm S history of the helping services by Levine and
50 years apn th f 21 S manY community programs developed more than
The if aVC 3 sur P>™ngly modern tone
in lOthcemurrEn^H 7 ']^ eXampIe ’ an or g a mzation that had its origin
itatimr the nn S n is essentially a community program for rehabil
mfficien The ! “ *?" a,m 15 t0 ‘he md.genf to become self

shelter and SSenlia com P onents of this program involve giving a man
shelter and honest ivork with the hope that he will lose h,s 'more repul

223

THE SETTLEMENT HOUSE MOVEMENT / 229

sivc habits’* ami accept work willingly Early m the Salvation Army’s his
tor) it was envisioned that once an individual acquired work skills and
proper attitudes, he would be given a portion of land to work This plan
was actuall) put into practice in the United States where, by the begin
ning of the 20th century, colonics existed in California, Colorada, and
Ohio involving approximately 200 workers Perhaps better known is the
work of the Salvation Army in developing residences, schools, orphan
ages, employment bureaus legal aid societies, life insurance companies,
day nurseries, halfway houses for prisoners, a youth corps, and a number
of other services for the urban poor Thus the Salvation Army is a rare
example of a community program established many years ago t at exis s
even to the present day

THE SETTLEMENT HOUSE MOVEMENT

Levine and Levtnc (1970) Imc desenbed the

meat, involving a variety of 20th centunes This was

large urban areas during .1 ' s "„g vast numbers of mum
a period when the United States , ar , , hose on the eastern sea

grams who settled in urban area i . 7^ conJld< , rable lgn orance

board where most Used in hardship, p V industm! revolution taking
of the new society that they had e socia j order and prompt

place at the time created further c lang w hose important

ed the need for community agencies to serve

needs went unmet by the estabhs le soc * , m res ponse to the prob
Settlement houses first appeare ir \ occurring there The English
lems created by the industna revo 1 ^ the working man Idealistic

programs focused on providing e UCJ * tvplC ally come into working class
intellectuals from the universities wo ^ were f ore runners of university

neighborhoods to teach in programs t j ie education programs concern
extension courses As an outgrow , Q £ t he general life and prob

developed for gaining a better un this understanding it was thoug t
lems of the working class o ac , nei ghborhoods and to expen
necessary actually to live ® hsh settlement movement prog

ence day to-day life there Thus th attempt tQ aHevtate a broad

retted from a concern w.th ( classes m England the Bnt.th

range of the problems besetting the £rom the settlement house

Labor Party recetved constderable -mpe^ ^ ^ Q A tlee and

movement, t.nce tome of ns e f^J ent m ,o pobttet with an eye to
Stafford Cnpps moved ir om al political action

solving social problems through na a role ,n the early settlement

In the United States the cliur r

9- prevention programs in
the greater community

^cific°rn amS d f SCribed U P to this P°i«t have been carried out within
are ennH nT. a S“tie S , particularly school systems. These agencies

laraf S “ e - Jor P reventi °n programs, since they bring together

lishmem of ’ ° £ Pe ° pk Strivi "8 ,oward a common end. f he estab-

probablv P ro S rams for atlu lts in the community at large has

natural si , e? n a^ m f red by “ ,e fact that there -e relatively few such
grams and th t ’ ■ W , several recent examples of community pro-
Levine nrnrvT asci ” atin S history of the helping services by Levine and
50 years 1 f?* 11 * many comm «nity programs developed more than
TheCf have 3 sur P r * s ingly modern tone,
in 19th-cennnt I tr Ar , ny j JO - r cxam P le ' an organization that had its origin
it a tin,- il.p n and ’ 1S esse nt,ally a community program for reliabil-

sufficient * The° r ** “ PreSS aim is “> ‘Cain the indigenfto become self-
shelter anil , WSentia components of this program involve giving a man
shelter and honest work with the hope that he will lose his •■more repul-
228

THE SETTLEMENT HOUSE MOVEMENT / 231

sheltering the 15-year-old bride who was being beaten regularly by her
husband.

The settlement houses had a stream of young residents who came for a
time to work in impoverished neighborhoods for many reasons. Some
were scientists and medical students, others were ministers or graduate
students, many were ardent feminists or people interested in social action.
Novelists, reporters, and writers commenting on the times came to the
settlement house in search of material. Living in the squalor of the urban
ghettos prompted a variety of philosophical concerns. There was guilt
among settlement workers concerning their own prosperity in comparison
to the poor and uneducated, as well as frustration at being a e to o so
little to change the lives of the impoverished. Many discussions were held
about broad issues such as social reform, the prob ems o ' ?V.
organization, and the problem of lifting the cultura eve o e
hood. The settlement house was more than just an .mportan tin ellecual

influence on its time, however. It was ^ ^ imnrovemen^
forms. Child labor laws, sanitation codes building c , P
in schools, and the establishment of juvenile courts all came about

result of the efforts of settlemen 1 ’ clean up neighborhoods. This

Some settlement houses led the fight P collection and rtis-

involved pressuring city officials to Sborhood groups lor the improv-
posal services as weU as °rganm««^ ht 5e ulement house workers
ment of sanitation. Projects of this k S ^ conflict of whether to

into the arena of local politics where [q e{ j ucate already estab-

enter the political scene themselves or sett i emen t house coincided
lished political bosses. Also the era o settlement houses lent sig-

with the rise of the labor movement, an c i ass [Q or ganize. Finally,

nificant support to the efforts o t e w r ore f ront 0 f many social welfare
settlement house workers were at t ® poorhouse system and relief
measures such as the reform o t ie . workshops, and the establish-
for the aged, the development o s m j oyme nt insurance,

ment of workmen’s compensation < organizational unit was the clu .

Within many settlements the esse j* duaIs having special interests.

These were formal organizations for m # boy . s cIub might be tie-

Holden (1922) has described the way

veloped (see Figure 1) ■ . var iety of activities, and Holden

This type of club might engag , |ie group took the club organ-

0922) has indicated many ways i i a manner many who came

izer as a model with whom to , e , vari ety of educauonal, rccre-

to the settlement house grew to

ational, and cultural activtt.es. scttIcro en. houses resulted tn ex-

The financial problems faced by

230 / prevention programs in the greater community

house development despite its relatively conservative nature in the 19th
century. Most churchmen supported the status quo, but some were criti-
cal o£ the business ethics of the day. Because the Protestant churches felt
a need for new methods to attract the workingman, religious settlements
and missions were established. These agencies had programs similar to
those of the YMGA and the Salvation Army. The religious settlements
and missions were cost-free institutions offering the services of a resident
minister, kindergartens, athletic and recreational facilities, classes, lec-
tures, schools, and a variety of other potentially beneficial community
services.

Perhaps the most significant feature of the settlement house movement
was that it attracted the contributions of a number of young, very well
educated women of the late 19th century. This was the first generation of
women managing to acquire higher education. Many of these women
were idealistic, socially conscious, ardently feministic, and deeply com-
mitted to justifying their intellectual advantages through useful works.
Among these women, Jane Addams. Lillian Wald, Florence Kelley, Julia
Lathrop, Alice Hamilton, Grace and Edith Abbott, Mary Simkhovich,
ant Vida Scudder stand out. The settlement house movement thus grew
out o a set of complementary needs. Many young, educated people were
seeking a useful outlet for their ideals and talents, and masses of needy
people were living in urban slums created by the waves of immigration
and were experiencing the upheaval of the industrial revolution.

ihbo Ca , ! * mencan settlement houses were established in the late
1880s and early 1890s in New York City. Creating a settlement house in-
. V ?, d r t mi j S t PaC<: ' sometimes "o more than an apartment, in the
E ° r °° wlKre service was to be provided. Settlement house work-
anarZ', y r g pe ° pk o£ Independent means, would move into these
f P H ° r h .° USeS l ° H y e am °ng those they wished to help. They of-
nublir h-ol? ^ ariety services to their neighbors, ranging from providing
and off ■ establishing libraries, organizing clubs, taking in the sick,
band On." 8 , ", f a " d her Children san ctury from a drunken hus-
nurse smH S f dement house worker, Lillian Wald, was a trained

from this ler sett * ement house emphasized nursing care. It was

V.shinv N T Settkment " °n Henry Street in New York City that the
Visiting Nurse Service was established.

th r^ OSt fa . mous of the settlement houses was Hull House, es-
House lu C ?° 1889 by Jane Addams - The mission of the Hull

grants to hX,™ Sha / e , * he T culturaI advantages with Chicago’s immi-
diverse activv'™*'; “ fU ' ler llfe for these people. This sharing involved
burial nursini- S !l UCh T ra5h! " E ne ' vborn babies, preparing the dead for
g the sick, acting as midwives at illegitimate births, and

THE CAMBRIDGE SOMERVILLE YOUTH STUDY / 233

gne funds only for specific purposes, or the patron might disapprove of
certain settlement house activities and withdraw support At times sup
port was offered in the form of a bribe with money available only if ef
forts to bring about a certain hind of legislative or social change would be
suspended funds of this hind had to be refused In essence the problem
was that the settlement houses depended for support on an establishment
that they were attempting to alter in many fundamental ways
The settlement house movement waned as the social need out of which
it grew declined The masses of immigrants gradually became assimilated
in life in America and left the ghettos, which themselves became more or
derly places The interest of eager, idealistic intellectuals declined and
the work of the settlement houses began to be taken over by trained pro
fessionals who were concerned with narrower problems than the sweep
ing issues that hid inspired the early workers In recent years there has
been a resurgence of broad social needs akin to those that stimulated the
settlement house development in the 19th century The aims an purpos
es of many recent community programs are strikingly sum ar to t ose o
the early settlement houses Therefore, much can be learned today from a
study of the experiences of the settlement house movement

A pioneering community effort to control juveni e e ^ '

problem commonly encountered in the settlement ouses
in the m.d 1930s by a var.ed group of professtonals Jhe C.mbndge So

merville study (Powers and Winner, 1951) operate settlement

luted mental health framework that was unhke that of the settlement

house

THE CAMBRIDGE-SOMERVIIXE YOUTH STUDY ^

The Cambridge Somerville Youth Study, a P^P*™ ncy /powers and
mid 1930s for preventing the development o q * ' This

Winner, ISSl/ts of great significance Timed member of
program was inspired by Dr R ‘ char , Concern ed with delinquency
the faculty of the Harvard Medical i>c Cabot firmly believed that the
and the reformation of the criminal, r ne should come to know

absolutely necessary condition was t at so f rien dly a way * ie
and to understand the man in so mtima e ^ truer comprehension of

comes to better understanding of himse an ^ v ) Cabot, there

the world he lives in (Powers and itme recrmt a group of people
fore, planned to identify predelinquents an a fnen dly, big brother re
to work with these youngsters m the °P e ant , SO cial behavior The op
lationship would deter the tendency example of a social being

portumty to relate to and identify wit a g

232 / prevention programs in the greater community

A certain group of boys averaging about fifteen or sixteen years got the repu-
tation of being "the toughest bunch on the block'" They used to stand around
drug stores and side doors of saloons smoking very cheap cigarettes and cat
calling at the girls who passed by They had a scorn for the conventional type
of hats and affected big caps pulled over their ears at curious angles They had
a peculiar way of spitting out of the corners of their mouths They punctuated
their sentences with words like Jesus and damn and hell, and others not so nice
in their original meaning They spent their evenings provoking trouble and
hunting for excitement One night they visited the neighborhood dance in prog
ress at a settlement (Admission 5 cents) Two of them were kicked out for
refusing to take off their caps, another was evicted for a rough house that ended
In breaking a chair, a fourth was put out for using profane language Three
remained They were engaged in conversation by a very large man they later
learned had been a famous football player at Princeton They were interested
in the gymnasium equipment The idea came to them that basketball could be
played by boys who didn't go to high school They asked if they could play
They were told that if they formed a club and had a director that they could
play They asked the big man to be their director and said they would get the
rest of their "bunch " But the rest of the bunch resentful over having been put
out, refused to come in They asked the big man if he would come and talk to
the others He did He spent an evening with them Where they went he went
also, but they noticed that he didn't catcall after girls and that he didn't wear a
cap

They came to the settlement house again and asked him to spend another
evening with them The big man said he didn't much enpy dancing on cellar
doors and proposed that they should go to a show Two of them hadn't any
money and asked him to wait while they "swiped a nickel off the soda and
candy man at the corner " He said he'd lend them the money They said that
would be all right that "they'd swipe it later " They noticed that he took off his
hat when he went into the movie house They asked if they couldn't form a
club and play basketball He helped them start their club

figure / Description of formation of a boy s dub (quoted from Holden 1922 pp
67-69)

periences that are enormously instructive for the organizers or modern
day community programs Not infrequently people or agencies who sup-
port programs like settlement houses attempt to exercise control over
their functions The settlement houses found that they depended on prt
\ate sources for most of their support These sources, however, might

THE CAMBRIDGE SOMERVILLE YOUTH STUDY / 235

coming from the public schools Other referral sources included com
munity organizations police departments playground supervisors and
social agencies

Once referrals were collected home visits were made to gather infer
mation concerning the home situation of each child Interviews in the
home were guided by a home visitor schedule filled m by social work
ers who visited the homes of the 8S9 boys The schedule included a de
velopmental history of the child the mothers description of the child s
habits recreational outlets attitudes towards school religion and general
personality The schedule also furnished background data to the parents
On the basis of the interview \isitors made a rating of the likelihood that
the family would cooperate with the study in the years to come as well as
a rating of the likelihood that the child was headed for a delinquent life
style This latter rating was made on an 11 point scale t at was to
used by the selection committee later Only 8 fami ies ou o , ,

to be interviewed Some were uncooperative at first but subseq y

STS* •“

teachers who used behav.or checklists and a ^ Jre personally
children were tested by psychologists as frank appraisal F.

interviewed concern.ng many children !° “ m J£n probation records
nally each child was given a physical exam ^ 5<:rvicc recon i s

of each child and those of his family were reu ^ irnount 0 f de

were surveyed the boys neighborhood was ratcl , sere , aken on

ltnquency normally found there and some ( beIn , lor „ as observed
a series of overnight camping trips nber j cIinqutn t career on an

Ratings were made of each boy s potentn potential rated in the

11 point scale ranging from +5 to — 1 f j ie j lom e MSitor a staff

minus direction These ratings were nn nn( i t he nurse or oth

psychologist the teacher interviewer the p

ers on the staff „ s o w retained for the study

Out of a total of 1953 screened cases < - ^ nVM l e b) a committee

The final classification of each of these a q 0 f ^liom had liad

consisting of a psychiatrist and two socn ' jn 0 f descriptions by
experience with criminals and dclmqucn ^ pj^deUnquent arc found in
several judges of children who were ratet

Figure 2 ,!,.«!< in the 301 . <4C ^

Of the 782 cases selected as possible J ( „, ri sieved as un

were rated as potential delinquents 1,u subjects (11%) ucrc r,,< '
hkely to go this direction The remaining ' | |p mllch ,„g

in the middle of the prognostic scale ' ir ,,lili< (physical health

patred boys who were smt.Iar on a ...» of personality tension
intelligence the relationship between

well-meaning, works and will gradually lose control Father's influence in the
broken family too far removed

Judge 3 —2 Negro, age 11, the youngest of four children in a home broken
by separation of parents (no details) and further handicapped by need of
mother working out, and hence inadequate supervision Fair district, though one
case of delinquency in same house or next, and a sister may have had illegitimate
child Boy has average intelligence and is in Grade V Bright but not interested
in anything but manual training Has fruanted at least 20 times this year and is
leader of clique of four Negroes a fighter and liar

Figure 2 Ti\o representative examples of rater descriptions of bases for judgments
(quoted from Winner and Powers 1951 pp 56 and 57)

displayed by a boy and the number of desirable tension outlets ^

the prognostic rating of the selection committee, an eva ua i
hnqnency sttmuht.on found the boy s home, and the neighborhood m
which he lived) Once boys were matched in pairs assig
ment or control group was determined by a coin ip

The Treatment Program

Kv O radre of nme full time counse
The 325 treatment cases were seen by a . soaa j wor )cers al

lors and one half time worker 1 hese were P nse ] or wa s asked to
though a few were psychologists or nurse* > wlth respect to cases

submit a statement of preferences an p J ^ keeping with these

that he might take on, and assignments were ^ cases an( j the

feelings Each fulltime counselor saw would see a case

half timer saw 18 It was hoped that ea j ative jy f e w boys were seen
continuously for a 10 year period Actua y ^

by a single counselor for the entire program counse lors at the outset
Several obstacles had to be overcome ^ ^ re q ueste d it Thus

First, they were offering help to peop e from the boy and his fami

there was the problem of winning accep osed further problems on

ly The constraints of the research destg P ^ {aml)y had a sl bhng
the counselor Often the project child *“ <* wa5 stlU required to

more in need of help than he was size wa s another prob em

concentrate on the research subject a seemed to be an msur

Befriending 34 or 35 boys and then . the program designers

mountable task Another limitation the boy s environment

was that no effort should be ma e mate community

Counselors were, therefore, forbadden^to^nitia ^ ^ neighbor hood
to organize clubs that might have g on t j ie project case
Instead they were required to focus e counselors was brea i g

Certainly a very major problem t0 the program ranged

ice” with the families they were to see

well-meaning, works and will gradually lose control Father's influence in the
broken family too far removed

Judge 3 —2 Negro, age 1 1, the youngest of four children in a home broken
by separation of parents (no details) and further handicapped by need of
mother working out, and hence inadequate supervision Fair district, though one
case of delinquency in same house or next, and a sister may have had illegitimate
child Boy has average intelligence and is in Grade V Bright but not interested
in anything but manual training Has truanted at least 20 times this year and is
leader of clique of four Negroes a fighter and liar

Ftgure 2 Two representative examples of rater descriptions of bases for judgments
(quoted from Witmer and Powers 1951 pp 56 and 57 )

displayed by a boy and the number of desirable tension outlets available,
^the prognostic rating of the selection committee, an evaluation of the de
inquency stimulation found in the boy s home, and the neighborhoo in
'ii/-h he lived) Once boys were matched in pairs assignment to treat
or control group was determined by a coin flip

- Treatment Program

The 325 treatment cases were seen by a cadre of nine full time counse
irs and one halftime worker These were primarily social workers al
ough a few were psychologists or nurses Each counselor was asked to
bmit a statement of preferences and prejudices with respect to ca es
at he might take on, and assignments were made tn keeping with toe
elmgs Each fulltime counselor saw approximately 3 i case and the

If timer saw 18 It was hoped that each r f " bivs were

continuously for a 10 year pertod Actually relatively few boys were see

by a single counselor for the entire P ro ^ a ™ ^ r '° colin5eIors at the outset
Several obstacles had to be overcome y requested it Thus

Vtrst, they were offering help to peop e w o la an( j jus fami

there was the problem of winning acceptanc further problems on
The constraints of the -carch design ^ . siblmg

counselor Often the project c i uas stl Il required lo

re in need of help than he was 1 ^ ^ another problem

tr-te on the research subject Oase , to j*, a n insur

ding 34 or 35 boys and their farm ^ program designers

untable task Another limitation > m P° . bo) ’ s environment

that no effort should be made to comml ,nity projects or

ounselors were, therefore forbi en mDact on the neighborhood
U organize clubs that might have general imp ^

Instead they were required to focus en » counse lors was breaking the
Certainly a very major problem Reactions to the program ranged
ice” with the families they were to see

236 / prevention programs tn the greater community

Example A In this case the boy gave the appearance of a predelinquent The
committee members rated him — 3 or — 4 with a final rating of — 3 (a high
delinquency rating, for the extreme — 5 rating was seldom used) This boy,
later placed in the treatment group, did not become delinquent at least up to
the age of 18

Judge 1—3 A highly neurotic boy emulating the neurotic behavior of the
mother by whom he is defended on every occasion A serious behavior problem
ot school, where he is recognized by several teachers as a potential source of
continued difficulty, which may be expressed in several types of delinquency
(truancy to escape unpleasantness, fighting os immediate reaction to any
restraint, and so on) Several siblings neurotic One brother has court record
for assault and battery There are now charges pending against boy for assault
on teacher Boy undisciplined and out of control m home Home situated on
margin of one of principal delinquency areas, and home during previous five
years located in one of worst delinquency areas Some of the outward appear-
ance of disorder tn home situation must be discounted because if is due to an
habitual excess of emotionality in facing all situations Boy may be expected to
encounter greater difficulty as he meets responsibility of increasing age

Judge 2—3 Poor pattern in both parents Mother distinctly neurotic and
children are taking on her self excusing impulsive traits with physical symptoms
Father is obviously evading Boy undisciplined and shielded by mother On the
streets much in delinquency area Is acquisitive and "cashing in" on an attractive,
glib personality in the easiest way Can't stand discipline

Judge 3 —4 A thoroughly undisciplined youngster, son of a highly neurotic,
aggressive mother who speaks little English One brother already on probation
for assault and battery Boy a problem in home and school Recently assaulted
teacher who tried to restrain him Mother also attacked teachers Is handsome
and spoiled Few, if any, assets and many liabilities

Example B This boy, tn spite of treatment, became a very serious delinquent
and was finally sentenced to state prison for a term of five to eight years for
armed robbery when he was 18 years, 8 months old Each member of the com
mittee independently rated him on the delinquent side at — 2 on the scale

Judge I —2 An unsupervised boy in a home broken by separation of parents
Boy a frequent truant and is developing anti authoritarian attitude at school
where he is leader, mischievous, lies suspected of stealing bold. Impudent Good
neighborhood and home furnished well, but little security offered by home No
criminality

Judge 2—2 Colored boy long without supervison at home and resents au
thorify Has built up poor work habits and evasive methods Already truants
much— possibly steals Is aggressive enough to get into trouble Mother, while

well-meaning, works and will gradually lose control Father's influence in the
broken family too far removed

Judge 3 —2 Negro, age 11, the youngest of four children in a home broken
by separation of parents (no details) and further handicapped by need of
mother working out, and hence inadequate supervision Fair district, though one
case of delinquency in same house or next, and a sister may have had illegitimate
child Boy has average intelligence and is in Grade V Bright but not interested
in anything but manual training Has truanted at least 20 times this year and is
leader of clique of four Negroes a fighter and liar

Figure 2 Two representative examples of rater descriptions of bases for judgments
(quoted from Witmer and Powers 1951 pp 56 and 57 )

displayed by a boy and the number of desirable tension outlets available,
the prognostic rating of the selection committee, an evaluation of the de
linquency stimulation found in the boys home, and the neighborhood in
which he lived) Once boys were matched in pairs, assignment to treat
ment or control group was determined by a com flip

The Treatment Program

The 325 treatment cases were seen by a cadre of nine full time coimse
lors and one halftime worker These were primarily social workers al
though a few were psycholog, Sts or nurses Each counselor was asked to
submit a statement of preferences and prejudices wit res PJ .
that he might take on, and assignments were made in keepi g
feelings Each full me counselor saw approximately 35 cue and the
half timer saw 18 It was hoped that each counse to v could. see a case
continuously for a 10 year period Actually, relatively few boys
by a single counselor for the entire program period

Several obstacles had to be overcome by the coumelors .Mj« ■ ^
First, they were offering help to people w o b and lm f aml

there was tile problem of winning acceptance , . problems on

ly The constraints of the research design slbIing

the counselor Often the project was still required to

more tn need of help than he was £ — « ^problem
concentrate on the research subjec , sceme d to be an msur

Befriending 34 or 35 boys and t le,r tlie program designers

mountable task Another limitation ‘ P , b0) ’s cm ,ronmcnt

was that no effort should be made to community projects or
Counselors were, therefore, forbi en tbc ncl ghborbood

to organize clubs tha, might have genera! .mpac. on tlm^g
Instead they were required to focus entire > ‘ j , brcaIon g U,c

Certainly a eery major problem for . most coin, dors ^

ice’ with the families they were to see Reactions P

238 / prevention programs in the greater community

from eager acceptance to marked suspiciousness and, in a few cases, out-
right rejection (only about 1% of the cases) The brief descriptions of
reactions listed in Figure 3 depicit the various degrees of acceptance en
countered

1 An Eagerness to Be Included in the Study (about 33 percent of the cases)

"Will Jeffrey be accepted by the Study?" his mother asked anxiously The
counselor explained that Jeffrey had already been selected She almost screamed
with delight and called the boy into the room She said how glad she was that
it was really true (The boy's father was dead the mother was working and
tp/ing to support her own mother and father as well as this boy who was then
only 12 ) She said she felt the need of having some man take an interest in her
son "What is the first thing you are going to do?" she asked eagerly The
counselor had in mind helping the boy with his studies, as he had been having
difficulty in school The mother going beyond the counselor's aspirations, said to
the boy, hugging him to her side, "Just think, Jeff, they will help you in your
schooiwork and when you grow up, they will send you to college*"

2 An Interest in the General Idea and a Willingness to Hear More about It
(comprising about 25 percent of the cases) Visiting Maurice's home for the first
time the counselor met a rather incredulous woman The record states

She shuffled to the door in her slippers and what looked like a mghtgrown
She had light red hair, looked very pale and ill, and her manner was not cordial
1 introduced myself and asked if she could conveniently give me a few minutes
time to tell her about the Study and that Maurice had been invited to be one of
the 325 boys to |om Ungraciously she said "I don't know what more information
I can give you " (Evidently referring to the first home visit and the questions
asked then ) She added she had been sick in bed I tried to persuade her to
let me return another time when she felt better and more like talking Somewhat
mollified she said, ‘ Now that you're here you may as well say what you want "
1 explained then that we were interested in boys and wanted to have a chance
to know a few specially selected ones, whose parents were interested We
thought it was going to be a good deal of fun and expected that there might be
some situations in which we might be able to help a boy develop his own special
ability She seemed to relax and become more and more pleased She raised the
question of what it would cost saying she couldn't pay anything She added
that she had had to stop another son's music lessons so certainly couldn't afford
to spare any additional expense for Maurice

Shortly the mother was talking about her own ill health She said, "I have
bronchial asthma and it has been wearing me out for nine years " The counselor
then discussed her problem She became more interested Several interviews

followed and the counselor became acquainted with the boy The mother called
upon the counselor for help many times during the ensuing years and a great
deal of time was spent with the boy

3 An Attitude of Indifference (about 16 percent of the cases) Lester's father
was home when the counselor made his first call "It is okay with me," he said,
returning to his newspaper and showing no further interest or curiosity concern-
ing the counselor's plans

4 A Suspiciousness about the Purpose of the Study (about 25 percent of the
cases) The counselor stated in Hank's record

Mr F answered the door He is a short, thin, wrinkled man with seamed face

He speaks broken English and seems quite suspicious of me He impresses me as
shrewd, sly, taciturn and reserved-he glared suspiciously at me I started to
explain my interest in Hank and the reason for my visit He listened a bit and
then said he had been out of work all year and didn't want anything to do with
it He called in another son, who was 24 years old The young man asked
suspiciously what it was that we wanted to do I explained this in terms of various
interests that the boys might have and in terms of our connection with the
schools, etc He said quite frankly that ,t sounded screwy to him Listen Buddy,
I've been around a hell of a lot but never heard anything like this Just tell

one thing you can do for Hank 1 "

The suspicion lingered for some time until the counselor was able to show the
family that he was sincere ,n h,s attempt to be helpful and that the program

would not involve any cost t „ Pr cent of the

5 A Reaction or Unwillingness to Hear More about It (about ' f Z"2e 0 f
cases) On the first visit to Rudolph's home the moth* quesbonr id . he va , ue of
the Study She kept interrupting the explanation o e Rudolph If he

the counselor assumed that there must be -e hmg wrong

had to be examined by a doctor, 5 ' j ^oMhmk’there was something peculiar
Why did he have a mental test if we mterested in her

about him* She went to the school t-nquirewhy ^ ^ , Q re

boy She reacted the explanation o e counselor was

assure her of the counselor's sincere interest She felt th^ ^ ^ ^ „

hidmg something She conclud ^ J^ fo ,h er who shared the suspicions of

guinea pig The counselor then ^ interested in my

L mother The father said, "There's "a a „en„on" The

boy, especially as there are so ma y "Every time one of you people

father became belligerent in his attitude an ' j , wcm , ge t at the

come around the boy's mother is a "^Xtupermtenden, (The parents go.
bottom of it " He said he would 'see tochers some cooperation was

touch with the school and with the » “

obtained, although the case never became an active __

Figure 3 Types of response
1951, pp 107. 108.109)

and " vm "'

240 / prevention programs in the greater community

In 1939 the program became operational with counselors being asked
to project a general plan for each of their cases. The goals of the counse-
lors included the following: “to supply a masculine ideal”; "to be a person
to whom the boy will turn for service that he believes is important to
him”; “to be available to the boy and family when needed”; and "to dis-
cuss family problems and work out plans with some continuity.” These,
however, were broad goals and reviews of counselor records indicated
that the following types of concrete activities were actually carried out:
“arranging for physical examinations, interpreting to the family, and so
on,” “taking a boy on educational trips to ‘see things/ ” "finding employ-
ment for boy and family,” “giving specific tutorial help in school sub-
jects,” "procuring legal advice for family,” and “getting much needed
clothes for the boy.”

As the project progressed its original objectives were reformulated.
The program had been concerned initially with preventing delinquency.
It was found, however, that although many children did not seem likely
to become delinquents, they were developing other problems such as neu-
roses. Thus a restatement of program objectives emphasized "continuing
social, physical, intellectual and spiritual growth” rather than delinquency
prevention. Another important change came about because counselors
were greatly overburdened by their case load. A particular problem for
these counselors was the “average” boy in the treatment group. These
joys, included largely for public relations purposes, were not expected to
become delinquent and were not manifesting serious problems. Working
wuh them proved trying for the counselors who were at a loss to find
ways of being helpful to such boys. Therefore, in 1941 and 1942, 65 av-
erage boys were retired from the treatment program.

Further attrition in the original study sample arose as time wore on. In
the early 1910s the eflects of World War II were fell in the project,
l ounger members of the counseling staff entered the armed forces neces-
sinning the introduction of new counselors and some shifting of cases. As
the project hoys grew older, some became uncooperative and had to be
dropped. Some families moved out of the area to distant locations making
it necessary to ternunate their children. Finally, older boys in the pro-
gram became eligible for draft or entry into the armed forces and left the
program for that reason. Thus, in 1913, all 17-year-oId boys were termi-
nated unless there was some special reason for continuing them. These
boys had a minimum of five years or more of treatment. The Cam-
bmlgc-Somcnillc study terminated formally at the end of 1915 at which
point 75 boys were still in the study. Table 1 below taken from Powers
and Winner (1931, p. 152) dcscrilms the disposition of the original 325
cases in the study.

THE CAMBRIDGE SOMERVILLE YOUTH STUDY / 241

Table 1 Disposition of the 325 Cases (from Powers and Witmer,
1951, p 52)

Retired in 1940 and 1941

Dropped before the end of the program
A Died during the treatment program
B Moved outside the field of operations
C Boy and/or family uncooperative
D Taken over completely by other agencies
E Mental retardation too great a handicap

F Following the reclassification during the war when the Study
could not retain an adequate staff it was necessary to drop
cases that were relatively less able to profit from the treatment
program

Terminated Most of the boys who had passed their 17th birthdays
in 1944 and 1945

Closed Carried through the entire treatment program

2

25

2

4

71

Total

65

113

72

75

325

Evaluation

Following the conclusion of the Cambridge Somerville program m
1945 an evaluation was made of its effects It was determined tta on
average each of the 325 project boys received 4 ^ars and 10 mon h^of
treatment The 75 boys who remained in the program “ >“ 0 ® aal ‘ e ™
nation received about 6 years and 9 months of trea J^t

been dropped from the program earlier received an average of only. ^

2 W years of attention j^eddmqu^a^he outset actually became
the boys who appeared to ^ q than on e sixth) were

delinquent m any serious sense Re ‘ a “""J (lons l The counse lors estimaled
actually committed to c0 ^ rec ‘ lon d about mo lhir ds of the boys they
that they had substantially be id ^ m%amM program acknowl
saw More than one half of the y cc _ r . ntIon with the study

edged that they had been helpe 7 ‘ ei ” te ,„ eC n the treatmen

The crucial comparisons l.oweve , de l,nqi.cncy bchav

the control groups Here - ^ ie ,f more trc med boys appeared before

i°r were disappointing For «™>P ■ (han control bo)S More treated
the Cambridge Crime Pre\en rc£ra rdless of age or the num

boys were taken to court than con o re cci\ed the most

ber of years in the study Even treated more officnI con

intensive efforts of the counselors w mltc hed controls No differences

tact with the police department than matched c^^

o hen ce s co m mu t cd ° Tlie on<T e nco u r a g 1 n g finding was that the more fre

242 / prevention programs in the greater community

quent offenders and those committing the more serious crimes were more
often in the control group than in the treatment group suggesting that, al-
though the project failed to prevent the early stages of delinquency, it
may have curtailed the delinquent careers of some youngsters.

In 1955, 10 years after the Cambridge-Somerville project terminated,
a follow-up study was done of the participants in that program by Mc-
Cord, McCord, and Zola (1959) . The results of these analyses were as
disappointing as were those of the original study. McCord et al. conclud-
ed that the study failed to prevent delinquency or adult criminality either
in terms of number of crimes committed or of number of boys becoming
criminals. The treatment and control groups committed the same types of
crimes at about the same ages, and treatment did not seem to prevent
crimes of violence, sexual offenses, or drunkenness. Roughly equal num-
bers of boys from both groups went to reform schools and committed
crimes after release from these institutions. The length of treatment did
not seem to affect the likelihood of being convicted of a crime, nor was
having one counselor through the entire treatment period an important
factor in limiting the crime rate.

Stanfield and Maher (1968) have done a relatively recent follow-up of
the data from the Cambridge-Somerville study. Their concern was with
the adequacy of judges’ predictions of the likelihood that subjects in the
study would manifest delinquent behavior. Stanfield and Maher’s conclu-
sion was that the clinical predictions of later delinquent behavior made
by the judges in the study were somewhat less accurate than were predic-
tions that could have been obtained by using actuarial methods based
solely on statistical base rates. Several reasons were suggested for the un-
impressive results of the attempt at clinical prediction: (1) judges
seemed to be predicting to "social maladjustment" instead of to the more
narrow criterion of arrest for criminal behavior; (2) judges seemed to
prognosticate with respect to psychological disorder rather than socially
problematic behavior, the standard used in the study to evaluate subjects;
(3) clinical predictions were based on written records of the subjects
based on reports by teachers, parents, and the like rather than on person-
al contact.

Summary

In summary, the Cambridge-Somerville study stands as an ambitious,
early landmark in community psychology. Despite its failure to produce
positive results, it merits attention as an isolated attempt at secondary
prevention appearing long before its time. It is a good example of how
such a project should be carried out and evaluated, and even its negative
results are useful for plotting the course of future programs. These results
suggest that future efforts at delinquency prevention might better focus
on environmental change than on direct counseling with individuals.

RECENT COMMUNITY EFFORTS / 243

RECENT COMMUNITY EFFORTS

In many respects, recent conditions in large urban areas are similar to
those at the turn of the century when the settlement house movement de
veloped Just as in the late 19th century when there occurred a massive
influx of immigration in recent years large masses of people have again
streamed into the urban areas (Zax and Cowen, 1972) The growth of
American inner cities lias not occurred this time because of immigration
from other countries but, instead reflects a marked population shift with
in the United States Whereas in 1910 more than 80 percent of all Amer
lean Negroes lived m the South, today fewer than 50 percent reside there,
and more than a third live in the crowded ghettos of our large northern
cities This population shift has undoubtedly been provoked by the same
need to seek a better life that earlier motivated the European immigrant
Also, like the immigrants of an earlier time, southern blacks are not find
mg that their lot in life has improved significantly in the northern city In
fact, for many, it was probably worsened As a result, the large urban
ghetto dweller is beset by a variety of problems that inevitably affect a
of society The frustration resulting in the urban riots of recent years are
dramatic examples of tl.ese problems, but there are many others such as
rising crime, alcoholism, and drug addiction rates and massive unemploy
ment Thus, recently many community psychology programs base been
developed that are directed at the problems of the inner city

The Lincoln Hospital Neighborhood Service Center Program

One approach for dealing with the mental health problc tms toft he inner
cty has been to permd

The 6 ltlea^for^the' development of NSCs .

Lincoln Hospital part of the Albert instem g L, n

York (Peck, Kaplan, and to^e enure South

coin Hospital had to provide m , . 350 000 On almost

Bronx region, an area with a population of about «0,00 ^ ^ ^

any index reflecting P s>cl '°P a ‘ Fj css education than residents of oil.
tremely high They me “S"'®' y . meomes, Inc in poor housing

er parts of New York City, and h e |U ,emlc delinquency, sc

base higher homicide and suin ' un( J plo)incnI The problem,

nereal disease, dnorce or sepir , ^ 0 f tins area is a stag

therefore, of presiding for the me . agencies in the area

Bering one Existing ^P™ proW ems t hey faced Residents of

had been entirely 0 ' C "' * A ummolsed and apathetic. Like the
the South Bronx area were relamcly hopeless

agencies, they felt that the prospects for change *

244 / prevention programs in the greater community

The Lincoln Hospital group determined that one obvious starting point
for dealing with the areas problems must involve broad social change
They decided to attempt to produce such change through a two-pronged
effort involving both existing institutions and the residents of the area
Consultations held with various community agencies as well as depart
ments within Lincoln Hospital such as medicine, pediatrics, and obste
tries indicated that the need for help with mental health problems could
potentially overwhelm all available mental health staff Such profound
need in the face of relatively meager resources inspired the idea of a multi
purpose clinical facility

Organization and Goals

The organization and staffing of the clinic facility that came to be
known as the NSC was based on interesting reasoning Instead of regis
tenng alarm at the appalling statistics of the South Bronx, the NSC on
gmators were amazed at the fact that these statistics were not worse con
sidering the conditions of life in the area This led to a recognition that
despite the fact that the community seemed disorganized, it must have
some unique informal organizational structure for treating and rehabih
tatmg its members that operated at least as effectively as the community
mental health agencies Therefore it was felt that the NSC should at
tempt to learn more about this informal community network and should
bring it to bear on community problems Concern was also felt about the
fact that the bureaucratic structure of mental health agencies makes it
difficult for potential clients to find points of entry to make their needs
known and to contribute to agency planning and operation Since the
NSC stressed community participation it was set up as a relatively simple
agency based in the neighborhood served The first NSC was established in
early 1965 in a storefront The operation of this center and others like it,
which were set up later, have been described by Reissman (1967) and
Hallowitz and Riessman (1967)

The character of the NSC and the services it offered are well depicted
as follows

" The NSC escapes the office atmosphere, shortens intake procedures
and makes them less formal, has no waiting lists, accepts any problem in
any form, does not require continued visits, catches people at the point of
crises, uses treatment agents recruited from the population itself who can
be informal, personal, and friendly It helps people with concrete, pres
ent oriented problems and provides directive advice and assistance (te ,
it does not demand that the individual do it himself ) Its staff is willing to
make home visits at any time and participates in all types of activities in
eluding funerals, outings, helping people to move, and extinguishing fires
tn apartments” (Riessman, 1967, p 163)

RECENT COMMUNITY EFFORTS / 245

The broad goal of the NSC was to promote positive mental health and
thereby to limit the development of pathology Three subgoals served this
larger goal (1) providing prompt mental health services broadly de
fined (2) increasing social cohesion within the neighborhood served to
provide community members with a sense of power and group involve
ment (3) promoting changes in community agencies and institutions to
improve their services An important means of achieving these goals was
community action Riessman (1967) contrasts community action to so-
cial action as described by Caplan (1964) Social action produces social
change through the influence of mental health specialists on legislators
and administrators By contrast community action involves influencing
those at the lower levels of society to make what changes they can on
their own and to pressure administrators for other necessary changes In
the NSC program individual services were offered as an entering
wedge into the community through which broader social changes even
tually could be brought about To the neighborhood the NSC was there
fore held out as a place to which any kind of problem can be brought

The NSC Staff and Program

The typical NSC was stalled by 5 to 10 nonprofessional mental health
aides indigenous to the neighborhood served and by oneorto o
sional mental health specialists who directed center

professional start played so central a role in the operaUon of the NSC

that an elaborate selection procedure was set up

Bed personnel Ultimately those selected *« trtri Jv

sionals as being highly empath.c | h av,n ^°° ^ ((> commumcate ,deas

being comfortable in group situation S lf „ war eness reacting

and feelings being J

adaptive 15 ; to streSS ^ 0 ! " experience Workers underwent a three

having relevant work and life e p ^ conducted by NSC staff pro-
phase training program The fi P , Menta l Health Clinic

fessionals and was based a. making community surveys

This three week training period assisting in hospital intake

doing door to door interviews wit ^ the we ]f a re department police
and visiting community 1 ^genc.e I concernmg man y aspects of

department and the schools R P> J haJe Dllnng the second

the job was also engaged in as P ar ‘ F ked a( an NSC for two

three week training phase aldes “ C NSC was uscd to render direct scrs
weeks Half of the time spent at e ujed to dls cuss on the job ex

,ce to area residents and thc The'rh.rd training phase was a continuous
penences with supervisors T e ope ration of the center

process that took place dunng systematic training to detelop

Roughly one day per week was spent on y

246 / prevention programs in the greater community

Miss Martinez

Miss Martinez came to the Center reporting that she was eight months preg
nant and that her common-law husband had deserted her last month She worked
until two weeks ago, but had been forced to stop working and had to move
into a basement apartment with a brother and his family The few dollars she
had accumulated were now gone and she had applied to the Welfare Depart-
ment for assistance They had rejected her at intake because they contended
that she must know the whereabouts of her common-law husband they couldn't
believe that she could live with a man for two years and not know more about
him

The aide, who spoke Spanish, explained to Miss Martinez why Welfare had to
make an investigation and encouraged her to tell whatever she could about her
husband All she knew was that he worked for a cab company, but didn't know
which company or where he had lived prior to their getting together The aide
suggested to her that they go together to the police station to see If it were
possible to locate her husband (The aides have had excellent relations with the
Police Department— they have visited the police station on a number of occasions,
and various policemen have dropped in at the Center to chat and keep warm)
The captain of the station, upon hearing the details of the case, dispatched a
member of his staff to the central taxicab bureau There It was discovered that
the woman's husband was in fact a cab driver, that he was wanted on charges,
but could not be located and had disappeared These facts were then reported
to the Department of Welfare Intake Unit, who felt that they were sufficient
to warrant opening the case for further investigation
When the aide checked with the investigator assigned to the case shortly
afterward, he was told that the field supemso* would, wtf fuMy accept the
evidence that was presented and still could not believe that the woman didn't
know where her husband was

Uncertain of what his role should be at this stage, the aide turned to his
professional supervisor The latter, in the presence of the aide phoned the
investigator and subsequently the Department of Welfare supervisor The aide
was able to observe his supervisor moving from the stage of reasonable discus
sion to the point of righteous indignation, pointing up that the recard was clear,
that the woman had worked and was self maintaining during eight months of
pregnancy, that our aide had visited the home and had observed the living con-
ditions and found they were as the woman had reported them, that it was not
atypical for a woman in these circumstances not to know more about the husband
than she did and the very fact that the Police Department couldn't locate the
husband should be proof enough of her cooperativeness, her dependability and
reliability

That afternoon the investigator stopped by the Neighborhood Servrce Center
to talk further with our aide The aide indicated that we wanted to work co-
operatively with Welfare, that we didn't want to serve as a pressure group and
pointed up all of the things which the aide had done prior to raising this issue
The investigator agreed that the woman could receive Welfare assistance, ar
ranged for an emergency allocation including back payment for carfares, the
grant also included money for a layette and for future carfare which would
enable her to take advantage of the prenatal service at Lincoln Hospital

The aide then helped Miss Martinez find more adequate living quarters On
the day she moved, which happened to be a Saturday, the aide assisted her with
the moving, helped her to wash down the walls, hang curtains, etc (This is high y
significant as the nonprofessional is now providing a mo e t° t ® ® I"' 5 '
chent-a model which seems to say that helping people even outside the line o
duty, not an a work day, ,s a good thing The nonprofessional was fun tionmg as
one neighbor helping another and was implicitly suggesting a
the helpee ,n the future might help another neighbor He was perjury ex
ample ,n line with our goal of transforming clients into helpers and citizens)^ ^

,he^itr,,h^

day at a modest stipend She complained rcia | cour!e work when she

has no marketable skills She has taken so arrange

was high school, but these the boby This

a modified training program for h D tfnent of Welfare When she Is

was worked out in cooperation wi mvestigator will attempt to

ready to return to work, both the a.de and the social

find suitable employment for her

rTlNScl^uoted from Hallow. tz and Rie«

Figure 4 The example of a case seen
man 1967 p 769)

new skills to further understanding of mental illness and to work

objective of the NSC, the prop ™ .foe ^ programs (Hoggs

ty that has traditionally been d,ffic ' or „l,o recognise injustices

trom, 1964) have appealed to the , lho feel capable of affect
are willing to engage actively in » program, however, w

ing change through tl.e.r own actions Th ( g( , he community

directed at the apathetic poof, a very ^ ^ , he m ,h.ant position

which, feeling powerless is unable ^ concrete assistance with

To organize them the NSC pr gr

248 / prevention programs in the greater community

specific individual problems. Once attracted to the NSC on this basis, the
normally apathetic individual could more readily be drawn into informal
groups run by people they knew from the neighborhood, in which the ne-
cessity for social change was discussed. Eventually such groups begin tak-
ing concrete steps to improve community services and to pressure for in-
stitutional changes. Examples of community action programs stimulated
by the NSC were voter registration campaigns, block cleanup programs,
antiviolence and antidrug campaigns, protests about poorly run local
agencies, and collaboration with school, welfare, and housing organiza-
tions to improve area life. Hallowitz and Riessman (1967) have offered
a good example of the way in which NSC aides could help a troubled in-
dividual (see Figure 4) .

What NSC organizers spoke of as community action often encom-
passed what can be labeled as political action. Voter registration cam-
paigns, efforts to force the improvement of community services, and pro-
tests over the quality of local agencies all constitute attempts to influence
the political process to serve better a constituency’s needs. It seems inevi-
table that community psychology programs, especially those located in
the greater community, should become embroiled in political issues. This
occurred in both the English and American settlement house movements,
which promoted much social legislation and were training grounds for
many socially concerned politicians. Philosophically community psychol-
ogy views social problems (crime, addiction, and poverty) as being
caused by unfavorable environments, so that political action aimed at
changing or alleviating adverse settings is appropriate.

From this viewpoint, community psychology, although interested in
helping the ghetto dweller to avoid a criminal career and to acquire an
education and the means for leaving the ghetto, is equally concerned with
eliminating the ghetto itself. Accomplishing this requires political action
to a large extent. The interspersing of expensive and low-cost housing in
newly planned communities is one means of forestalling the development
of a ghetto. In long-established communities the aim of urban renewal
programs can be to replace ghettoes with safer, more comfortable, and
growth-enhancing settings.

It should be emphasized, as the example of the NSC also demon-
strates, that the target problem of the community psychology program is
usually not a traditional one for mental health workers. Thus, even a suc-
cessful solution to such a problem may have little immediate effect on
schizophrenia rates or the prevalence of psychoneurosis. In fact, im-
proved social conditions leading to reduced crime rates might conceivably
result in increases in certain types of mental disorders. Preventive models
must, therefore, be targeted specifically to the behaviors to be modified.

Evaluating the effects of the NSC program is not easy, particularly

RECENT COMMUNITY EFFORTS / 249

over the short term The baste problem ts that it is very difficult to estab
lish a direct relationship between NSC activities and their eventual ef
fects on the community Over a long period of time, the demonstration of
dramatic changes m the negative demographic characteristics of the NSC
area, in the absence of other apparent community forces to account for
them, would speak to the beneficial effects of the NSC program There
are, however, bases for a current evaluation First, it was extreme!) eco
nomical (Riessman, 1967 ) The total operating expenses for one of the
early centers, including the salaries of the professionals, nonprofessionals
a secretary, rent, and other expenses totaled less than $50,000 per
year Since centers were expected to serve communities populated
by 50 000 people, this represents a cost of only about one dollar
per person Furthermore, in terms of center utilization, Riessman (1967)
reports that during a six month period when two NSCs were in full oper
ation, they averaged 1037 cases per month Projecting these figures ap
proximately 6200 would be treated at each center per year Since the av
erage family size of individuals served by the centers was approximately
3 9, each NSC affected the lives of roughly 25 000 people per year
When one adds the potentially beneficial effect of the NSC on scores of
others through the institutional changes it stimulated, it is possible to pre
diet a profound impact on many social problems

The Residential Youth Center (RYC)

Goldenberg (1971) has described the development, operation, and
evaluation of a short term residential setting designed to promote person
al growth in culturally deprived adolescents and their families Strongly
emphasized in the project is the development of an institution realistically
capable of promoting this growth In creating a new type of institu
tion, Goldenberg rejects many basic assumptions of other programs, such
as the Job Corps that attempt to deal with inner city youth One Job
Corps assumption is that the poor can best be rehabilitated in settings dif
ferent from those in which they live Rejecting this, the RYC bases its
program in the same neighborhood where the client must Ine and adapt
A second common assumption of many programs is that mental health
professionals make the best staff in programs dealing with the culturally
disadvantaged Rejecting this assumption, the RYC staff consists largely
of indigenous nonprofessionals A third common assumption in the de\el
opment of most institutions is chat the leaders should specify the goals and
values of the institution In the RYC the views of both staff and residents
enter into goal setting and decision making

Organizationally, a pyramidal administrative structure was asoided in
the RYC Such a structure was seen to reflect a number of assumptions

250 / prevention programs in the greater community

detrimental to RYC functioning These include the notion that a man will
avoid work unless he has a boss that he prefers being led to taking per
sonal initiative, that he is self centered and insensitive to the needs of the
organization and that there is nothing instrinsically fulfilling about the
work that he does Concern that functioning under a pyramid'll structure
would lead RYC workers to believe and to accept these assumptions
about themselves and to behave accordingly, led to the adoption of a hor
izontal organization Such an arrangement permits the staff to learn from
one another, to develop a collective clinical sensitivity and perspective, to
accept personal responsibility, and to develop an open and trusting at
mosphere

At a practical level the horizontal structure requires that each staff
member, regardless of his title in the organization, assume a case load
with total responsibility for all decisions and interventions concerning a
resident and his family Other staff might attempt to influence decisions
concerning a particular case, but the final determination is always made
by the member responsible for that case Along with clinical duties, all
RYC staff shares in the work of other members Thus, although different
staff members hold different titles and perform functions for which they
are best suited they also share functions wherever necessary On the
cook s day off other staff members take turns preparing meals Although
there is a regular live in staff, other staff members are expected to relieve
them on days off so that everyone takes turns living in Administrative du
ties are distributed to several different staff members Each is expected to
inform the others about his administrative functions but administrative
power is not concentrated in the hands of any one person
Despite the fact that the RYC program was ultimately directed at
neighborhood youth considerable emphasis was given to staff growth
and development It was felt that personal growth on the part of staff
would render them better able to provide optimal service to the young
people treated at the RYC Therefore staff selection and the staff train
ing program was a central feature

Formal background or training was considered to be relatively unim
portant for potential staff Instead commitment to the work to be done
at the RYC and previous experience working with the types of boys who
would be serviced by the RYC were the qualities sought in prospective
staff members Those designated as director and deputy director of the
RYC interviewed applicants for staff positions No tests of any kind were
administered The interview included an explanation of the RYC pro-
gram, invited the applicant s reactions to what he had heard, and encour
aged a frank discussion of the problems faced by the program A recogm
tion of community problems and a willingness to voice dissatisfaction
with existing conditions were qualities sought In many respects, such in

RECENT COMMUNITY EFFORTS / 251

divuluals Ind been looked on as troublemakers by other community
agencies The RYC program director kept a diar) of reactions to inter
\ lev. ees, and Figure 5 depicts one particular interview

Of the original RYC stiff, eight males and a female secretarj, five
ivcre white and four black, and all were indigenous to the inner city Vir
tinllj none had lnd formal training m ps>cholog>, sociology, or social
work and onl> one had earned a professional degree Most were high
school graduates Their occupation'll experience was diverse and mclud
ed an automobile mechanic, an Xra> technician, a supermarket em
plojee, a professional singer, a policeman, a baseball plajer, a book de

Interview 12 May 1966

Today, Scotty and I interviewed Jack T I think we both knew, even before the
session was over, that we wanted Jack as one of our RYC workers As soon as he
left the office we kind of looked at each other, both of us knowing, almost
without a word, that Jack was the man for the job

So far. Jack is the only guy we want to hire who is not a work crew foreman
Although Scotty has known him for some time, I never met Jack until today At
the present time Jack is a Neighborhood Worker working out of the Newholl
ville area He is a Negro, 34 years old, married, and has four children. Prior to
coming to work for CPI he was a packing house worker

Jack came a few minutes late for the interview and as soon as he came in he
greeted Scotty, nodded to me, and took a seat from which he could look out of

the window and onto the street ,

Scotty and 1 began in the usual way We told him about the |ob and about the
RYC program as a whole We gave him Ihe usual spiel about it going to be a
program "unlike any program ever run", about how we wante to wor
kids and families ,n ways which were different and unorthodox ° bout h ° w
wanted to create a program that would allow the staff to develop the own
talents and would encourage and help people to assume the total
for working with a client and how, when I left ,n January, nobody would be
brought Ingram the outside to run the program, but that movement would come
from within the staff It was the usual pitch « j ac k he

During the who, e time and continue to stare

“J,:r ^ rrx r "s

saying or that he |ust plain didn t care salary that the ,ob would

here the first place* It couldn't be " of the salaryjha^ ^ ^ ^

carry because no one knew what ' „ , ot of other openings in CPI

— - * - - pte ° pp,y

I think that my most vivid impression of Jack and of the whole situation was
that I was sitting and talking to a man who acted as if he had heard all this
before, had been "put on" many times by stories that stressed "growth, responsi
btlity, and advancement," and just couldn't care less about "words" When we
asked him about what he was doing at CPI, he responded by saying ' Officially
or on my own?" Naturally, we said 'Both," and Jack took it from there He
told us in a somewhat bored way about his "official" duties as a Neighborhood
Worker and about how he is supposed to contact and recruit people for the
Employment Center but not to get "too involved with them" on a personal or
counseling basis He told us about how he drives people to and from appoint
ments, offers them "support," and does some follow up work after they have
been placed on jobs or in training programs

The only time he kind of lit up was when he began telling us about his "on my
own" work With a bit of a glint in his eye (I must have imagined this because
I rarely saw his eyes, what with him almost constantly staring out of the window)
he told us about his nighttime activities about how he works with "shook up
kids" from his neighborhood how he spends all his time talking with them on
street corners and in their homes and how he tries to keep them out of trouble
by involving them with him in a makeshift |udo program (JackT is a black belt in
judo)

Although he never said so, I got the feeling that one of the reasons Jack
enjoyed his night work was that he was able to function in some of the very
ways in which he could not work during the day In other words at night and in
formally, he could indeed get close to his "clients," counsel them, become
deeply involved with them, and deal with their problems in a direct and un
restricted manner

I also got the feeling that Jack was a fairly angry guy He mentioned once
or twice, always in passing, about how little he felt "the professionals" with
whom he worked and who now supervised his activities knew about slum kids He
made no effort to hide the fact that he was somewhat disillusioned and unhappy
about the way the War on Poverty was going Despite what seemed to be his
strong feelings he remained outwardly calm and completely self possessed
It was a strong interview in many ways I guess mostly because the more
Jack spoke about his concerns and reservations about all CPI programs (and, by
implication, the RYC program), the more convinced 1 became that I wanted him
on the staff

When the interview was over, and as Jack was leaving the office, I said to
him "Jack, if we hire you as an RYC worker in our program do you think there's
a chance that some day you'll look me straight in the eye and not stare out a
window when you talk to me 9 ' He almost, but not quite, smiled and said
"Maybe, we'll see "

Figure 5 Notes from an interview with an applicant for an RYC staff position
(quoted from Goldenberg 1971 pp 136 137 and 138)

RECENT COMMUNITY EFFORTS / 253

partment manager, and a packing house worker What they did share was
a good knowledge of the workings of the inner city Besides the full time
staff members, six part timers — Yale University students using their
RYC experience as part of their training — were also part of the staff
The first RYC clients were young people who had had extensive expe
rience with traditional agencies and had been given up by these orgamza
tions The first 20 RYC residents came from families suffering chronic
unemployment, serious disorganization, and considerable interpersonal
conflict Most of the boys had police records, had served time, and were
doing poorly in an elementary job training program sponsored by a local
community action agency A few were thought to be capable of success
but were regarded as being held back by their poor home situation None
of the boys had completed high school, and all had been involved in local
community action programs Twelve of the first 20 youngsters were black
and 8 were white, they ranged m age from 16 to 20 They averaged 2 9
arrests per individual for offenses such as loitering trespassing petty
theft, breaking and entering, burglary, and assault Only 3 of the 20 had
never served time in prisons reformatories, or institutions for the mental
ly retarded or emotionally disturbed Nearly one half of those institution

alized had spent more than a year at the institution

It was hoped that the RYC program would bring a youngster and his
family together under circumstances permitting mutual growth To ha
end, the youngster’s worker attempted to dispell the idea that the family
was losing the child to the agency or that the agency was assuming paren
tal responsibility Instead the worker attempted to sene as a catalyti

“Tt'any one time the RYC housed 20 boys and worked with then | f™.

lies, hopefully to become a •' " £y Id K
program goals were straightforward ( ) P „_ m s of

members fo find work or to enter employment oppormn.ty
interest to them, (2) to help the youngster an n j

the problems that presented their having . > more f.dfil mg 1*. Md TO ^
make it possible, within a short time, for I e P Dunn g the days,
live w'.th the family or to set up his own .pa men « >

RYC residents were expected to he "“^sThtornfacquamtetl with
tins period, the case worker visited familmsm f „ rc5 ,

them Special weekend and e ' en ‘ g „ P lh f cntire community These pro-

dents and their families, and eien * i carpentry, automobile

grams were based on special staff «««*•»* “ “ Cment. atl.lct.es,
mechanics, judo, remedial aura, suiting

and group sens. m.ty session ^ rc5 , dens were encouraged to

hours were unlimited, and tl or nlght Residents paid rent

come to the center at any tun

1 think that my most vivid impression of Jack and of the whole situation was
that I was sitting and talking to a man who acted as If he had heard all this
before, had been "put on" many times by stories that stressed "growth, responsi
bility, and advancement," and |U$t couldn't care less about "words" When we
asked him about what he was doing at CPI, he responded by saying 'Officially
or on my own?" Naturally, we said "Both," and Jack took It from there He
told us in a somewhat bored way about his "official" duties as a Neighborhood
Worker and about how he Is supposed to contact and recruit people for the
Employment Center but not to get "too involved with them" on a personal or
counseling basis He told us about how he drives people to and from appoint-
ments, offers them "support," and does some follow up work after they have
been placed on jobs or in training programs

The only time he kind of lit up was when he began telling us about his "on my
own" work With a bit of a glint in his eye (I must have Imagined this because
I rarely saw his eyes, what with him almost constantly staring out of the window)
he told us about his nighttime activities about how he works with "shook up
kids" from his neighborhood how he spends all his time talking with them on
street corners and in their homes and how he tries to keep them out of trouble
by involving them with him in a makeshift judo program (Jack T is a black belt in
|udo)

Although he never said so, I got the feeling that one of the reasons Jack
enjoyed his night work was that he was able to function in some of the very
ways in which he could not work during the day In other words, at night and in
formally, he could, indeed get close to his "clients," counsel them, become
deeply involved with them, and deal with their problems in a direct and un
restricted manner

I also got the feeling that Jack was a fairly angry guy He mentioned once
or twice, always in passing, about how little he felt "the professionals" with
whom he worked and who now supervised his activities knew about slum kids He
made no effort to hide the fact that he was somewhat disillusioned and unhappy
about the way the War on Poverty was going Despite what seemed to be his
strong feelings he remained outwardly calm and completely self possessed

It was a strong interview in many ways I guess mostly because the more
Jack spoke about his concerns and reservations about all CPI programs (and, by
implication, the RYC program), the more convinced I became that I wanted him
on the staff

When the interview was over, and as Jack was leaving the office, I said to
him "Jack, if we hire you as an RYC worker in our program do you think there's
a chance that some day you'll look me straight in the eye and not stare out a
window when you talk to me? ' He almost, but not quite, smiled and said
"Maybe, we'll see "

Ftgure 5 Notes from an interview with an applicant for an RYC staff position
(quoted from Goldenberg 1971 pp 136 137 and 138)

RECENT COMMUNITY EFFORTS / 255

taking a long range perspective on program progress When major crises
arose, special sensitivity sessions were used as emergency “cabinet ’ meet
mgs

The center was located in an area of New Haven that had once been
mostly middle class and largely Jewish The character of this neighbor
hood, however, had begun to change during World War II and by the
time of the program’s conception, it was populated largely by lower and
lower middle class families (approximately 60% white, and 40%
black) The building housing the center was an old 15 room Victorian
house standing on the corner of two main streets Originally a single fam
ily home, it had undergone several changes as the neighborhood declined
Its metamorphoses included use as a boarding house and, later, as a
“house of pleasure ” Immediately before being taken over as the RYC,
the building had been a rooming house for transients and was in a state

of considerable disrepair

To evaluate the effects of the RYC program, boys were chosen as con
trols at the time the original residents of the RYC were selected Subjects
were selected for both groups by having each of a number of community
social agencies provide a list of the 50 boys within the required age range
whom they regarded as their most difficult cases Those boys foun on
the lists of several agencies were regarded as the most difficult, and those
found on the fewest number of lists were regarded as least difficult me
first 25 of the most difficult boys were placed in the experimental group
with 20 being admitted to the RYC, and the remaining 5 available as
substitutes for dropouts from the original group The group o w
were regarded as least difficult constituted the control group U ,
two groups were not equivalent in social deviance, but they were matched

with respect to age and race 4

Outcome evaluation was based on occupational adjmOMnt . attitude
changes and community adjustment as reflecte in > n '° ^ found

gal authorities With respect to occupational ad J" s ™“ attended

that prior to initiation of the RYC program con J

woZpproxunately 86 percent of >.me wherea: «« boys, were

working only approximately 60 percen h program, these differ

part.cpa.ton by experimental subjects ‘ ‘“^vere amending work a P
ences were dramatically con.rols uere attending only

proximately 97 percent of the time wh difference Vocational

56 percent of the time a statistically records Boys

status changes paralleled these chang decreaS e ,n unemployment rates
in the RYC program showed a sharp employment Small

(39 7%) and a sharp increase (5 «%) ™ ^ categories Income also
changes were found in the control gr P ^ Qn entry in to the

reflected the beneficial effect of the P

254 / prevention programs in the greater community

and were permitted to go home whenever they wished. It was hoped that
the center would be regarded as a place in which people, not patients,
worked and lived and grew, as they might in any good family.

Because the RYC staff felt the need for a vehicle for facilitating com-
munication, group meetings were held three times weekly for all full-time
staff and clinical psychology interns. Called sensitivity training, these
meetings differed in many respects from T-groups in which participants
are encouraged to express a great deal of emotion in the presence of
group members who will not be seeing each other in the future. Instead,
the sessions at the RYC served a number of important local purposes.
One of these was to deal with the problems that would inevitably arise
out of the program's organizational and interpersonal features. For exam-
ple, the horizontal organizational structure was bound to create problems
for people who are accustomed to hierarchical organizations. Further-
more, the fact that in the RYC a racially mixed group of individuals were
living and working together in an emotionally close relationship led to the
expectation that considerable interpersonal tension would arise among
the staff. The group meetings were also expected to provide an opportun-
ity for self-reflection which could help prevent the RYC’s becoming dom-
inated by its own structure. The group experience was intended to con-
tribute to the growth of staff as clinicians by increasing their sensitivity to
human feelings and interpersonal problems. Finally, the group was used
as a forum for mutual decision making and for the development of a feel-
ing of mutual trust, and to provide continual feedback on what was hap-
pening in the institution.

The RYC program utilized three forms of sensitivity training, each tai-
lored to the organization's specific needs: individual sensitivity , group
sensitivity, and special sensitivity. The individual sensitivity approach was
used for one meeting per week. The remaining two meetings could be de-
voted to any one of the other types as seemed necessary at the time. The
most personalized of the meeting formats, individual sensitivity, was di-
rected at providing a randomly selected individual with feedback con-
cerning how he was coming across to others. Some attention was also de-
voted to the way in which the group was reacting to this particular indi-
vidual. Group sensitivity sessions were “open meetings” where any staff
member could bring up a problem that he felt was affecting any individu-
al’s functioning or the group as a whole. Thus if one staff member began
to sense that he was finding it difficult to relate to another, he could raise
this issue without waiting for an individual sensitivity session devoted to
that other person. Group sensitivity sessions could also involve attempts
to gain perspective on the program, the staff members involved, and how
both were changing over time. Special sensitivity sessions were held infre-
quently, usually only once in six months, and were primarily devoted to

RECENT COMMUNITY EFFORTS / 257

(Schwitzgebel, 1963, 1964, 1967, Schwitzgebel and Kolb, 1964, Slack,
1960, 1963) The model for this approach originated in a study on the
dynamics of hostility Seven male adolescent delinquents were hired to
participate in interviews and to take some psychological tests for the pur
pose of this study Surprisingly, it was discovered that the scientist subject
relationship had positive behavioral effects on the delinquents Slack
(1963) has described his relationship as a collaboration m which the ad
descent and the experimenter regard themselves as scientists doing a
"job for the community ” The job in this case is attempting to lower the
crime rate Schwitzgebel (1963, 1964, 1967) describes extensively the

approach used m such a program

Prospective “employees” are actively solicited from among individuals
frequenting pool halls, street corners, or any location where adolescents
with records of delinquency seem likely to congregate Once it is estab
lished that the boy has a police record he is offered a job as an expert
mental subject He is told that he can earn spending money simply y
showing up at the storefront laboratory and talking into a tape recor e
A typical conversation from a first contact is described in Figure b

Bill end his friends gathered around a pinball machine on wh ch . had us.
won nine free games After I had given Bill several
conversation was recorded as nearly as possible by a friend who
along for this purpose I had not met Bill previous y

Experimenter Have you ever been ® ht off guar d by the direct

Bill No, not me How came you ask? [Bill is caugnt o g

question He thinks perhaps this guy is a co P been in some trouble I

Experimenter We„, -his guy - -e

rmght have a |ob for you [B V , hing5 ore Be ,„„g interesting ]

new kind of cop Or maybe h P , + n roll drunks or what?

Bill What do you mean? Y° u f b We - re try ,ng to 6nd out how

Experimenter No, it's a different kind of pbW ^ ^ ^ ^

come kids get into trouble and what ^ anything you want,

out IS to ask them You |ust talk int P ^ do || ars an hour You don t
but mostly about yourself You can g P but it's good pocket

get rich 'cause you only work a couple ° b ° ^ „ w0 os k them and they

money We want to And out why k.ds get Into

tell us , „ doesn ' t really believe the experimenter

Bill You're nor a cop, are you I uirec j a police record?]

Who ever heard of a "^ a, ? h '' 'f,^ ow „omes or p,aces or anything l.kethor

Experimenter No, we don t want )h , nk abou , , MngJ Id like some

Just what's happened to you, and wta V ^ ^ (he |undl counter on the
coffee, let's talk about It over here [Bom

256 / prevention programs in the greater community

RYC the experimental group boys a\eraged $25 per week as compared
with $29 per week for the control group Nine months later the RYC
group was earning an average of $45 per week as compared with $20 72
for the control group

With respect to community behavior, the average number of arrests
per RYC youngster in the six month period before entering program was
1 87 as compared with 1 70 for the controls For the six months after
they entered the center program the RYC residents averaged only 0 96
arrests as compared with 2 08 for the control youngsters a highly signifi
cant difference statistically Similarly during the nine month period prior
to the opening of the RYC experimental group boys spent a total of 153
days in jail as compared with 140 days for the control group For the
nine month period following initiation of the RYC program, experimen
tal group boys spent a total of 70 days in prison as compared with 258
for the control group another statistically significant difference

Attitudes were measured by a variety of questionnaires designed to tap
feelings of alienation and attitudes toward authoritarianism, trust, Ma
chiavellianism and social desirability Comparisons between experimen
tals and controls at the initiation of the RYC program showed no differ
ences on these measures Six months later, however, the RYC group was
found to have become significantly less alienated and to have decreased
in feelings of authoritarianism as compared with the control group The
RYC boys also showed a tendency toward greater trust as compared with
the controls but this difference was just short of significance

These initial findings of the RYC program effects are very impressive
If long range follow ups substantiate the differences already reported
the RYC program would appear to hold considerable promise for dealing
with some of society s most difficult problems Besides rehabilitating the
youngster set on a course of serious social maladjustment the program
has the advantage of being relatively economical The RYC is run on an
annual budget of approximately $150 000 Since approximately 50
youngsters can be served m any given year (at an average of 5 y 2 months
of residence per boy) the average cost is only $3000 per resident Since
the costs of dealing with a boy in juvenile court is higher and the cost of
supporting a youngster who remains on the welfare rolls over a long peri
od of time can be infinitely higher than this figure the RYC approach
would seem to be a very compelling one both from economical as well as
humane viewpoints

Community Programs for Delinquents
Behavior Modification in the Storefront Laboratory
Several reports in recent years have described attempts to diminish de
hnquent behavior through the use of behavior modification principles

RECENT COMMUNITY EFFORTS / 259

time a boy is met, whether late or not, he is immediately rewarded by the
experimenter, most often with a cigarette or candy bar. Eventually most
boys began coming to the laboratory on their own.

The initial task in this program is to induce boys to come to the labo-
ratories for their meetings, even if several hours late. Once this is accom-
plished, efforts are made to encourage punctual arrival. This is done by
introducing a system of paying for the full hour's work only if a boy ar-
rives roughly on time. If he is late, he is permitted to work only the re-
maining part of the scheduled hour and paid only for the portion worked.
A system of bonuses may also be introduced whereby prompt arrival is
occasionally reinforced with extra gifts such as money, or tickets to a

baseball game.

The “work" engaged in by the adolescents consists, simply, of
talking into a tape recorder. It is explained that the experimenters are in-
terested in learning about teenagers who have had trouble with authori-
ties and are not attempting to reform the boys. The boy is encourage to
join in the experimenter's efforts to learn about why adolescents ave
problems with established authority. Experimenters are completely can-
did about the purposes of the project and its operation and the boys are
therefore, encouraged to ask as many questions as they wish and to read
any publications or correspondence related to the project. e imp
of one subject (see Figure 7) in this study after only three weeks tn he
project indicates the impact this simple procedure can have on del.n

T'an early evaluation of this '•street corner -search" Schwi.tgebel
(1954) compared 30 boys who had been seen 10 ‘ ' a . ed b mat ch-
riod of six months or more to a control group o 7* having rec-

ing members of the experimental f ou P ' v '“ d the youth Service

ords in the Department of Probation and Parole andme ^ ^ ^
Board of the Commonwealth of assac 1 c j ty G f residence,

variables such as the first major o et ' s ^’ ; son prior to February

and amount of time spent in re -inn sc > ^P^^, subjects

1959. On the average, both experim incarccrat-

committed their first offense at about age 15 K „
ed for approximately 15 months be ^ ‘ “ th( . P lwo groups were compared
One postexperimental index on " f|er thcir involvement with

was the mean number of arrests three ) of 2 .4 arrests while

the program. The ex Pf r j™ enta r £°" n P ce that is statistically significant. A
the control group had 4.7, a . d subjects and nine (45%) control

total of seven (35%) experimental s it j ^ ycar (ollo „.. u p period, a
subjects had been incarcerated during ^ significm t differences

nonsignificant difference. T icre " ’ t institutions as t ic

between the groups in the number of months pe

other side of the amusement center and order coffee Experimenter pays for
both ] It's a job We're doing research It's an experiment, and you get paid for
being one of the guys in it I know it sounds corny We've got a little white rat
at the lab and we're teaching him to do tricks That's his part in the experiment
Other people do other things Your job would be talking into a recorder
Bill You mean I'm a guinea pig’ [He is beginning to get the idea of the job
He is also a little pleased that some one is seeking him out for a legitimate job ]
Experimenter That's right Some of the guys call it guinea pigging Most all of
them like it, and bring their friends around for a job, but we like to start with
new guys who don't know us

Bill Say, you're not a bug doctor, are you? [Fear of the psychiatrist is intense
To associate with one voluntarily in gang territory would immediately cause the
loss of gang prestige and protection ]

Experimenter No, I |ust help out I'm a student There's other people like me,
and there's Dr Slack He's the big man who runs the outfit He's a prof at the
school where we run the experiment

Bill You're not a bug doctor, huh? If you are, I won't go
Experimenter No, I |ust help out with the experiment You get paid in cash,
and you can quit whenever you want to You've really got to see the place be-
fore you make up your mind It's a pretty good deal, and it's on the level But
maybe you don't have a bad enough record, because we need kids who've
done time You look like you've been around
Bill I've done time

Experimenter Good Let's take a look at the place You can bring your friend
along Look it over, then make up your mind Nothing to lose, and it's something
to do

Figure 6 Example of the first contact with a prospective subject (quoted from
Schwitzgebel 1964, pp 14 and 15) Reprinted by permission of the pubhsners from
Ralph Schwitzgebel, Streetcorner Research Cambridge, Mass Harvard University
Press, copyright © 1964, by the President and Fellows of Harvard College

Typically the experimenter brings the new employee to the laboratory,
often with a friend, for the first session On arrival the delinquent is gen
erally reinforced with soft drinks food or a cigarette If the boy comes to
the laboratory on his own the first time, at the conclusion of the session
he is invited to return the next day at the same time If he was met on the
street the next meeting is arranged for the next day in the same location,
and he is again brought to the laboratory A boy initially met on the
street often presents a problem about returning If he fails to do so within
several hours of an appointed time, the experimenter returns to the
neighborhood where he was found and tries to seek him out If not found
on one day, he is sought the next day In particularly noncooperative cas
es, a procedure called "shaping'' is used In this procedure the boy is met
at locations successively closer geographically to the laboratory Each

RECENT COMMUNITY EFFORTS / 261

time experimental subjects participated in the study Experimental sub
jects had a total of 20 interviews in the course of a two to three month
period The posttest results of this study indicated the experimental group
that was reinforced for prompt behavior was significantly more likely to
arrive near the starting time than the experimental group that did not ex
perience such reinforcement Likewise the same group which had been
reinforced for positive statements about other people showed a sigmfi
cantly greater increase in these statements than did the experimental
group that was negatively reinforced for hostile statements The experi
mental group receiving negative reinforcement for hostility decreased in
their average frequency of such statements but although the decrease m
this group was larger than in the other two groups the differences were

not significant ~

Measures were also taken of various social behaviors that might reliect
tact and consideration for others Two of these tests yielded signi cant
differences One involved the amount of food that a subject wou or er
at a restaurant when limited to a maximum of one dollar On the aver
age all three groups showed an mcrease between the pre and postMon
this behavioral measure (meaning their total was c “er to t ie ° t e d
limit on posttest) but the experimental group that had been re nforced
for displacing desirable behav.ors showed a significantly smaller mcretne
than dtd the other two groups The other behavtoral m ast re on whmh
significant dtfferences were found mvolved a test m «h£h subjects w
asked to list for five m, notes all of the bad things that th y m.ghtcm ^
then later all of the good things that t L.° d m the two 5 minute

tween the number of thoughts that cou jy reinforced for

segments The expenmental group that had been pcm ^ the

socially desirable behavior showed a stgmfi

number of good thoughts than dt ples in street corner and

The efforts and achievements of P ire impres sive Such a

storefront experimenter subject c0 ^ 51gmficanc e of which is in

program reaches out to a socia p . set on a course where their

contestable involving as it does you g P ever b ur dened Because of its
own lives will be wasted and socie y mauency has been the object

significance as a social problem juvem ^ ^ e falled despite am

of many early community efforts mos Cambridge Somerville study)
bilious and energetic programs (e ■ S laboratory are hopeful and

The results of the work of the st
should be extended and tested further

Modeling Procedures with Juvenile meet the special nccdsof

The creation of le-irning s,tl,atl ""! ' “jfh jmen.le delinquency Samson
delinquents Ins also been used to deal 1

260 / prevention programs in the greater community

I have been a part, material wise, in the program at Harvard University, titled
' Research Center in Personality and Rehabilitation" for a period of 3 weeks
The person in that department I work with is — —[the experimenter] Who is a
Jesuit priest finishing a degree in Sycology at this University Now the mam
purpose of this program is to get material and also at the same time, help
troubled people who have delinquency dealt with the law, who naturally have
many different types of problems Myself being a person under that description
can be of use to this program I must honestly state, that in my such short period
attending here so far, ! have never since I can remember, felt greater mentaly
Although it has only been a short period of time, as I mentioned, I feel a great
decrease in my trouble with facing reality I hope it is possible for me to con-
tinue my attendance for quite awhile Because I still have much more information
to give to this program about myself, and different things I also feel there is
much more knowing I can receive about myself here I have, as most troubled
people, always thought that I would never straiten things out But now since
attending these visits I have put a whole new light on everything concerning life
and myself And the light is on the good side, one hundred per cent After find-
ing this information out on such a short visit here, I am sure enough of everything,
to say that the outcome of this will be excellent, not only for me but everyone else
that attends this program If this program was greatly increased I feel both sides
would benefit greatly I hope I have expressed myself as well as I wanted to
about this matter

Figure 7 One subjects reaction to experimenter subject therapy (quoted from
Schwitzgebel 1954 pp 54 and 55)

result of offenses committed with the experimental group averaging 3 5
and the controls 6 9 months Even though roughly equivalent numbers of
experimental and control subjects committed crimes leading to mcarcera
tion the fact that significantly fewer crimes were committed by experi
mental subjects and that they spent significantly less time in penal institu
tions is quite encouraging

In a later evaluation Schwitzgebel (1967) compared the effects of an
experimental procedure in which boys received positive reinforcement for
arriving at work on time and for making statements of concern about
other people with a procedure in which boys received negative reinforce
ment for negative statements about people and positive reinforcement for
socially desirable nonverbal behavior that reflected social tact or desira
ble employee qualities A third group in this study was a no treatment
control group m which subjects participated in only 2 interviews spaced
over a period of two to three months, approximately the same amount of

RECENT COMMUNITY EFFORTS / 261

time experimental subjects participated in the study Experimental sub
jects had a total o£ 20 interviews in the course of a two to three month
period The posttest results of this study indicated the experimental group
that was reinforced foi prompt behavior was significantly more likely to
arrive near the starting time than the experimental group that did not ex
perience such reinforcement Likewise the same group which had been
reinforced for positive statements about other people showed a signifi
cantly greater increase in these statements than did the experimental
group that was negatively reinforced for hostile statements The expen
mental group receiving negative reinforcement for hostility decreased in
their average frequency of such statements but although the decrease in
this group was larger than in the other two groups the differences were

not significant

Measures were also taken of various socal behav.ors that might reflect
tact and consideration for others Two of these tests yielded significant
differences One involved the amount of food that a subject would order
at a restaurant when 1, ratted to a maximum of one dollar On the aver
age all three groups showed an increase between the pre and posttest on
this behavioral measure (meaning then- total was closer to the one dollar
limit on posttest) but the experimental group that had b«n reinforced
for displaying desirable behaviors showed a significantly smaller increase
uiapiayjug t i ier behavioral measure on which

than d,d the other two ^J^vfd * test wh “ h *«

significant differences we things that they might do and

asked to list for five minutes A ratl0 was taken be

then later all of the ***?*?££& Jeered m the two 5 minute
tween the number of thoughts tha posmvely reinforced for

segments The expenmental group that had « P increase ln the

socially desirable behavior sho^d^^g ^ other two groups
number of good thoughts than examples in street corner and

The efforts and collabo rat,ons are impress, ve Such a

storefront experimenter suDje rob]em lb e significance of which is in
program reaches out to a socia pro ^ on a course where their

contestable involving as it does y isr ^ everb urdencd Because of its
own lives will be wasted and socie Y delinquency has been the object
significance as a social problem ]“' of whlch j iave faded despite am

of many early community efforts th e Cambridge Somerville study)

bittous and energetic programs (eg ]lboratory are hopeful and

The results of the work of t ,e

should be extended and tested furthe ^

Modeling Procedures with Juvenile ^ fo mccl [bc special needs of
The creation of learning si™™ 1 * • j ien ,Ie delinquency Sarason

delinquents has also been used to deal

262 / prevention programs tn the greater community
(1968) and Sarason and Ganzer (1969) have pointed out that as one
who has been rejected by the mainstream of his culture the delinquent is
deficient in socially acceptable and adaptive behaviors These experimen
ters have therefore set about to provide opportunities in which the delm
quent can directly observe and learn socially useful behavior

The rationale for this approach is that delinquents need to be exposed
systematically to models with whom they can identify who display social
ly appropriate behavior in situations relevant to the delinquent s life ex
perience Pilot studies using modeling approaches have been earned out at
the Cascadia Reception Diagnostic Center in Takoma Washington where
all children committed by the juvenile courts of the state of Washington are
sent Preliminary work, was devoted to determining what model situations
should be presented how models should behave toward delinquents to
maximize the effects of the observations and to experimental issues such
as the controls that must be used to evaluate such a project and what
types of dependent measures are necessary for assessing program effects
It was concluded that relatively objective and uncomplicated modeling
situations must be used and that good rapport between models and sub
jects was vital if the program was to have significant impact — models
must be people with whom the delinquent wants to identify Eventually a
series of 15 situations were designed that could be modeled for delin
quent boys Each presented in a single session provided opportunities
for delinquents to learn adaptive responses to problems they were likely
to experience Session themes involved situations such as applying for a
job resisting peer pressure to engage m antisocial behavior approaching
a teacher or parole officer with a problem and putting off immediate
gams in favor of long range gratification Efforts were made m each
modeling example to stress the generality of the lesson to be learned from
the specific situation A typical example of a modeling situation involving
application for a job is presented in Figure 8

Six people attend each modeling session Two are models (advanced
clinical psychology graduate students) and the other four are delinquents
typically ranging in age from 15 to 18 One of the models introduces the
topic for the session and describes the theme which everyone present will
ultimately play The two models act out the scene which is structured
carefully beforehand Following this example a pair of delinquents is in
vited to act out the same scene Afterward a round of soft drinks is
served and a discussion is held on various aspects of what was observed
and acted out Later the boys who have not already done so act out the
scene In discussions following the job interview modeling example four
points are emphasized (1) a boy takes initiative in these scenes rather
than waiting for things to happen to him (2) a delinquent must often
deal with the fact that he has a record (3) feeling anxious at a job inter

RECENT COMMUNITY EFFORTS / 263

Job Interview Scene

Introduction Having a |ob can be very important It is a way that we con get
money for things we want to buy It is a way we can feel important because we
are able to earn something for ourselves through our own efforts For this same
reason, a ,ob can make us feel more independent Getting a |ob may not always
be easy This is especially true of jobs that pay more money and o u time jo
A [ob may be important to guys like you who have been in an institution ecaus
,t gives you a way of showirfg other people that you can be frosted, that you
can do things on your own, that you are more than |us, a punk kid However,
because you've been m trouble, you may have more ,roubl " ,ha "
getting a ,ob In the scene today you'll have a chance to prad»ap P^°
|ob and being interviewed by the man you want to work for Be g
Lakes most people tense and anxious because mtennewe *

which are hi to answer After each a, you has een — d, , we J II M
about the way ,t felt and about what to do about the special p
parolees may face in getting |obs

Scene 1 a ^ , e -nnivmq for a lob at a small factory

A boy who is on parole from Cascadia i P ^ ^ hopes to do so by

in his home town He is 18 and has not finished h g ^ Th|s w|| como up

going to school at night Obviously, t e oy kondles this problem This

during the interview Pay careful attention to ho* ^ ^ q ^ obout
is a two part scene, first, we'll act ° u ... you wa nt a |ob
another way of convincing an emp oyo knocb on the door )

(Mr. Howell ,s seated at h,s desk when Geo 9e kn ^

Howell "Hello Have a seat I'm Mr Howell, ana y
(Mr Howell rises-shakes hands )

George "George Smith
Howell "Have a seat, George "

(Both sit down ) , . L ere There are a few questions ^

"Oh yes, I have your application rig , e || me about them

to ask you I see that you have hod som r lobs b ,, yo ^ g „ ng to *hool
George "They were ,us. far the summer^ ^ q ^ , fln ,

we!b ' Tdid quit' 'on^o^l* ho „ your senior year ,n high school

VoudTn't InmndLo ’gS h amr°" , ,„ tcnd to go to

George (showing some anxiety) ^ ( ^ IO m y d

I'm working It may take me a yea
Howell "How did you get a year

George 'I've been out of school for a while because I've been in some
trouble Nothing really serious "

Howel! I'd like to know |U$t what kind of trouble you've had, serious or not "
George "Well, I was sent to Cascadia for six weeks but I'm out on parole
now I just got out a couple of weeks ago One of the reasons I want a pb js to
help keep me out of trouble "

Howell "What kind of trouble were you involved in’"

George "A friend and 1 stole some car parts and parts off an engine I
guess we were pretty wild I'm not running around like that any more though "
Howell "You sound like you think you can stay out of trouble now Why do
you think so?"

George ' In those six weeks at Cascadia ! thought about myself and my future
a whole lot, and realized it was time to get serious about life and stop goofing
off I know I haven't been out very long yet, but my parole counselor is helping
me with the problems that come up I'm trying to stay away from the guys that
I got into trouble with I really think that if I could get a job and be more on my
own it would help a lot "

Howell "Yes, I think you're probably right— but, I'm afraid we don't have any
openings right now I'll put your application on file though and let you know if
anything turns up I have several other applications too, so don't be too
optimistic "

George "All right Thank you "

(George stands and starts to leave as he says this line )

Scene I b

Introduction It is now two weeks later George has called back several times
to see if an opening has occurred He now stops by to check again
(George knocks on Mr Howell's door )

Howell "Come In "

George (enters room while speaking) "I stopped by to see whether you had
an opening yet "

Howell "You certainly don't want me to forget you do you?"

George "No sir, I don't I really want a job, l think its the best thing for me to
do now"

Howell "You know, I believe you I wasn't so sure at first It's pretty easy for
a guy who has been In trouble to say that he's going to change and then do
nothing about it But the way you've been coming here and checking with me so
often, I think you're really serious about it "

George "Yes, sir, I am I started night school this week I think I'll be able to
get my diploma in a year So, if I had a job now I'd be all set"

Howell "Well, I've got some good news for you, George I have an opening
for a man in the warehouse and I think you can handle the job if you want It "
George "Yes, very much When do you want me to start?"

Howell 'Tomorrow morning at 7 30 "

George "OK"

Howell "I'll take you out there now and introduce you to Mr Jones, who will
be your supervisor."

Scene 1 c

Introduction Same as Scene lb
(George knocks on Mr Howell's door )

Howell "Come in "

George "I stopped by to see whether you had opening yet"

(enters room white speaking)

Howell "You sure are persistent Have you tried other places?"

George "Sure, I'm checking back on them too Getting a good t ob isn't easy "
Howell (uncomfortably) "Ah, well, look We're not going to have a place for
you here I wouldn't want you to waste your time coming back again We can t
use you "

George (rises to go) "Well (pause) O K Thanks for your trouble
Look, what's up? I know that your company is hiring other fellows like me right

now " , .

Howell "Er . that's true Uh, I'm afraid that we have a company policy not

to hire anyone with a record " #

George "How come’ That doesn't sound fair to me
Howell "Well, er, ahem that's |ust the company s policy I m sorry,
my hands are hod There's nothing I can do about ,t " „

George 'Well, I would have appreciated knowing that right a y
Howell "I'm really sorry I con see you're trying I hope you get a ,ob
George 'Well, do you know of o place that could use me’ Smce you
personnel, maybe you've heard something "

Figure 8 ExampleTT^^
and 262)

view is quite understandable, (4) persistence

is a trait that is valued by

employers * t Stu dies to assess the effective

Sarason (1968) has reported two pi m modeling sessions were

ness of modeling procedures In one, received n0 special treat

compared with two contro gr° u P , aneo usly enacted roles similar to

ment and another in which bo >' s SR b ‘ h]ch ha d not been modeled for
those used in the modeling situation b foUowed by a de

them In a later pilot study modeUngs^ue^ ^ ^ on A ^
tailed group discussion in which gr , Experimental-control com

sonal meaning of group i meeting J d on behavioral ratings

pansons were based both on self report ^ ^ seIfrep0 rt procedures re-

provided by the institution :

266 / prevention programs in the greater community

quired subjects to describe themselves as they felt they were and as they
would like to be Behavioral measures focused on table manners, lying,
peer relationships staff relationships, and performance on weekly details
These measures were made during the boys’ first 10 days at the mstitu
tion and, again, just prior to discharge

Initial evaluation efforts have yielded several interesting findings
Tirst boys participating in the modeling groups tend to show a greater
discrepancy between “me as I would like to be” and “me as I am now"
than do control subjects This indicates that those experiencing modeling
become more dissatisfied with themselves the longer they stay at the insti
tution This stirring up of self dissatisfaction may well be a necessary pre
cursor to important behavioral changes A further finding was that boys
in both experimental groups the modeling group as well as the role play
mg group, changed behaviorally and attitudinally to a greater degree than
did matched controls who had no special treatment program These dif
ferences were most marked in the subjects who participated in modeling
A further analysis indicated that boys who were characterized by the
greatest amount of anxiety responded most favorably to the modeling sit
uations

The promising findings m these early studies of the effects of modeling
on die behavior of juvenile delinquents have prompted an extension of
this work Studies are now being devoted to increasing the power of the
modeling situation through the use of closed circuit television, thereby
providing greater observational opportunities New kinds of control
groups are being introduced to more closely approximate psychotherapy
groups And, finally, research is being done on the personal charactens
tics of the most effective models

The New Careers Movement

A relatively new approach for dealing with the myriad of problems
suffered by the impoverished is the New Careers Movement, which is
dedicated to improving economic conditions among the poor through ere
ating career opportunities in the service professions In addition to im
proving the material state of the impoverished, such careers should help
diminish the pow erlcssncss felt by the impoverished and should enhance
their self image Thus the New Careers Movement has a significant po-
tential for preventing mental disorder

Pearl and Ricssman (1965) have written movingly of the necessity for
developing new careers for the poor They point out that in a highly tech
nologically advanced society even the skills of the well trained profes
sional rapidly become obsolete At an early stage of technological devel
opment the poor, traditionally society’s least well educated group, had
one important resource that gave them a toehold on the economic ladder.

RECENT COMMUNITY EFFORTS / 267

their capacity to perform unskilled labor For many, this opening was
sufficient to permit their children to advance to higher stations in society
through adv anced education or business enterprise For a long period of
time, technological advance stimulated the economy and provided still
more and more openings for the unskilled Advancing automation, how
ever, has gradually been eliminating the need for the unskilled labor tra
ditionally provided by the poor Thus other avenues for advancement are
now needed by the impoverished Through the service field. Pearl and
Riessman env lsion that the poor can find one such avenue Their faith is
well stated m the introduction to their book

" The central thesis of this book is that in an affluent automated society
the number of persons needed to perform such tasks (services in the
health , education, welfare, and recreation fields) equals the number of
persons for whom there are no other jobs’ (Pearl and Riessman, 1965,

P 6)

Basic to the new career concept is the creation of jobs out of activities
that have traditionally been carried out by highly trained professionals
but that can be done at a technician level, or the creation of new jobs to
provide needed services that are not currently available In either case,
these jobs should be established at a level permitting easy entry for the
relatively untrained and unskilled Beyond this first step of creating jobs
suitable for the poor, .t is also necessary to enable an adult to have a c
reer in a gtven field Thus permanency and an advancement ladder “
be bu.lt into the job These requirements necessitate cons.deraMe
thinking of the functions of the typical professional and demand much
administrative and legislative reorganization While ^se ^pec.s of .he
new careers concept are ambitious and difficult to implement, another
pect further compounds this difficulty , new ca

In addition to making possible

reer, without the necessity for ro fessional advancement

ic to the new careers concept that ^ k r or lt There

be possible for those who are “P ab ! e f els wlt h relatively little

fore, one might enter a profession tumor colleges and col

training Job experience P 1 " 5 f “« «r e ima . ^ a( a hlgher level

leges might then provide one envisioned that die new careerist

within the profession Ultimate y profession Thus, where up to

can aspire to the highest station wit , psychology, or education
now one has entered a field such “ ™ "ng to work, it ,s pro-
only by acquiring very high eve ^‘ tIja f t i, e opportunity lo achieve the
posed in the New Career A o\ those who enter vwth no skills

highest professional levels , the r , cW j n medicine, therefore,

and work their way up gradually w medical assistant, even

one might begin as a hospital aide, advance

268 / prevention programs in the greater community

tually proceed to being a medical associate in which more demanding re-
lationships with patients are engaged in under a physician’s supervision,
and then take on increasingly more significant challenges until, ultimately,
one reaches the status of the medical doctor. In a sense this concept calls
for a return to a time when people entered professions as apprentices, at-
taching themselves to an established professional who served as their tu-
tor over a period of years. They entered with virtually no training and
eventually, through experience, achieved the status of a full-fledged pro-
fessional. This avenue has been closed with the development of high level
professional schools. Unfortunately, the poor have little access to these
schools, and those who champion the New Careers Movement feel that
something like a return to the old tutorial system is necessary if the poor
are to have a genuine opportunity to advance. Thus the entry level to the
service profession should not require extensive training and education
which the impoverished lack, and the opportunity for advancing through
work and training in the profession should exist.

The new careers concept has stimulated the development of a wide va-
riety of service jobs for the poorly educated and impoverished. Riessman
and Popper (1968) have described potential and actual programs offer-
ing career opportunities for the poor. These are found in social welfare
agencies, in schools, in various health services, as well as in the correc-
tions and police agencies around the country.

One of the pioneering efforts in the New Careers Movement was a
program developed at Howard University in Washington, D. C. (Fish-
man, Klein, MacLennan, Mitchell, Pearl, and Walker, 1965; Fishman,
Denham, Levine, and Schatz, 1969; Klein, 1967; MacLennan, Klein,
Pearl, and Fishman, 1966) . This program was designed to provide ego-
enhancing employment in the human service field, for young, people, fac-
ing a seriously limited future because of their lack of skills, poor educa-
tion, and police records. If successful, such a program would have two
major dividends: it would help to alleviate serious manpower shortages in
the human services field; and it would convert a young person, who
would otherwise become a liability to society, into a productive citizen.

Trainees for the Howard University New Careers Program were, re-
cruited through a variety of community agencies and sources, some tradi-
tional, such as the United States Employment Service, the Division of
Vocational Rehabilitation, and neighborhood development centers of the
Community Action Program, and some untraditional, such as the Proba-
tion Department, news stories, posters, and word-of-mouth contacts. The
application procedure involved merely filling out an application form, un-
dergoing a physical examination, and participating in an interview. Elimi-
nation of those applicants failing to meet minimal requirements left a far
larger number than could be worked with; hence, several selection proce-
dures were adopted to reduce the size of the group. One procedure simply

RECENT COMMUNITY EFFORTS / 265

involved random selection from the total pool of acceptable candidates
In other instances, the interview was used as a device for selecting apph
cants with certain special qualities Still another way of selecting apph
cants involved choosing on the basis of sex or some desirable personal
characteristic Differences in selection procedure came about because
trainees were being selected to work in a variety of different settings In
many settings no special characteristics were required so that random
selection was possible Others required certain minimal qualifications ne
cessitating the creation of priorities for people possessing them Mainly
the selection program was keyed to screening in applicants rather than
screening them out

Overall the Howard program trained a total of 136 people, ranging in
age from 16 to 35 years, with the majority (89%) under 26 Most
(about 2/3) were married and 58 percent were males All but two of the
trainees were black with more than 50 percent having been born in the
District of Columbia Over 90 percent had had previous job experience
but only 7 percent were employed at the time that they entered the pro-
gram Thirty nine percent were high school dropouts The majority of the
group (65%) had been arrested Thirty five percent had between 1 and
5 arrests for offenses ranging from simple misdemeanors to burglary,
housebreaking and assault Figure 9 describes a typical trainee

Aide X finished the tenth grade at a Washington DC high ^h°o before
quitting school altogether He ,s somewhat small ,n stature and when first seen,
h,s tendency to wear clothes one or two sizes too large only a e n. a. d th
fact He gave the impression of being an extremely wary and
who hardly ever looked at or spoke directly to w J
In the early days of the program he was quite crltica ' of P }h / group
tioned the possibility of its having any e ect on e , directions for
members At the same time, he was qu.ck a pa has lived far 17

action and to assume leadership He is one o ive h housewife

years a. the same address (a public haus,ngpro,ectl ^ ^ ^

and his stepfather, a post office emp ° y ” c f a conflict wth his step

become more self sufficient, at leas P , . homo an aunt's apart

father He has alternated between living ^"ecord Includes a series cf
ment, and an apartment of his own is P ^ of was a one-dolla-

low paying, unskilled, temporary jo s st record Includes cha'g^J of

an hour kitchen helper Aide X's = nquc confned to a correct onal in

robbery and truancy For bath of these
stitution (Fishman et al , 1965, p

SUTUTlon iremnuH — # • _ — ■ ,

at llwm! Lnimwiy

F, P u~9 DaafO. - ■ ^ ”

Trom Fishman ct at- 1°65 p H)

270 / prevention programs in the greater community

The Howard University program prepared trainees to work in a vane
ty of roles teachers aides recreation aides welfare aides, and the like
Since different trainees were being prepared for many different jobs, one
element of the training program was an on the job experience designed to
teach the specific requirements of a given setting Also, specialty instruc
tion was offered to provide the skills and knowledge necessary for a par
ticular job Common to the program of all trainees however, was the
Core group This was a vehicle designed to help trainees assimilate the
values and expectations of the world of work’ and to see the relevance
of their own efforts to other people The Core group was defined in the
Howard program as

a training group in which its members would learn hoxv society
small groups people in general and they themselves felt, functioned, and
developed Within this group aides learn how to analyze personal, social
and particularly job related problems, make their own decisions, try on
various roles and attitudes for size, and learn to cope more effectively
with people and the world mound them

Starting from their own experience, the members of the Core group
are encouraged to examine the process of their immediate lives and the
problems of living in a poor area of the city As the group progresses, it
draws upon experts to examine with it areas of knowledge of common
concern to all These include problems of human development, ic,
family life childhood adolescence normalcy and deviance community
institutions and resources special problems of the socially deprived,
health care labor and employment the lau and legal aid credit unions,
insurance and medical care and general problems of working with peo
pie (Tishmanetal 1965 pp 18-19)

Core group sessions were held daily for the first half of the three
month training program and ranged from one to three hours as a function
of the topic under consideration During the latter half of the training
program it met only twice a week allowing increasing amounts of time
for on the job experience

Once training was completed the Howard University Program design
ers played a major role in job placement Also many trainees were hired
by agencies in which they had trained

A follow up evaluation was done with 106 out of the 136 new career
ists trained at Howard based on trainees job experience since leaving the
program Follow ups were done no less than 6 months or more than 2 1/2
years following completion of training (Fishman et al 1969) In this
group 92 (8*7% of the sample) were employed at the time of follow up
and those employed had held their present job for an average of 9 months
with the majority (about 53%) having had only a single job since train

RECENT COMMUNITY EFFORTS / 271

ing The remaining interviewees had held from 2 to 4 jobs The major
follow up findings showed tint among trainees who were employed when
inters tewed, viturally all were still working in the human service field
Approximately one half of the job changes taking place were for reasons
beyond the trainees’ control Also most job changes resulted in salary m
creases Approximately one third of the interviewees sought further
schooling after their new careers training Of considerable significance
was the fact that only 8 out of the 102 followup trainees reported con
flicts with law enforcement agencies A total of 15 offenses were reported
by these trainees Five were for traffic violations and the remaining 10
were for somewhat more serious offenses This record is m marked con
trast to that reported in the pretraining period when approximately one
third of the trainees reported a total of 79 delinquent acts

The overall results of the Howard University program are extremely
impressive, particularly when one considers the nature of the trainee pop
illation This example of a successful program for converting ; people who
are ordinarily a liability to society into human service workers ta. «»

lated a variety of new career programs diroughout the coun.ry Su h p^

grams are, of course beset by a number of difficulties but have P
tential for solving some of society s most serious problems

Mental Health Consultation

. t0 vrapple with community mental

St, 11 another approach designed to grapp ' m by mental health

health problems is the wider prac t(> pro f essIO nal groups

specialists Typically such COn ;“!' a “ 0 " raining m the mental health fields
that although having little specia % many people

nonetheless ,n the ordinary course of their «^ a[her5 , general pract.
experiencing mental health P ro era ll[emen and welfare workers
tioners clergymen P robatl ° n °® C “ Z 64) an d B.ndman (1959) have
are professionals of this kind p \ oups Bindman defines

written about consultation practices with these group

mental health consultation as fo ow s or m ter P crsonal

Mental health consultation is an t fesslom l workers, the con

relationship that takes place e w worker, the consultant, attempts

sultant and the const, Itee, in mh,ch o „ menta l health problem of

to assist the other worker, t e co ' , t j lg cons ultee‘s usual profes

a client or clients, within the fra uUatlon de p e nds upon the com

sional functioning The process f through this relationship,

munication of knowledge, skills, and at , nuU eetual

and therefore, , s dependent upon the dp ^ ^ o/ process ,i one
involvement of the two ™ mkers Uttrn to handle similar cases in the

of education, so that the const, Uee can

272 / prevention programs in the greater community

future in a more effective fashion , and thus enhance his professional
skills (Bmdman,1959,p 473)

Caplan (1964) has described four types of mental health consultation
The first client centered case consultation focuses on the consultees
problems with a specific client The primary goal is to help the consultee
deal most effectively with the client but a secondary goal in this as in
most consulting approaches is to improve the consultee s functioning so
that he will be better able to handle similar cases in the future

The second type of consultation program centered administrative
consultation deals with the problems encountered m administering or
creating programs for preventing treating or rehabilitating the mentally
disabled These problems typically relate to the planning and admimstra
tion of services and to the formulation of high level policies concerning
the most effective recruitment and use of personnel An example of such
a consultative procedure is a psychiatrist s being called in by a city health
department to advise on establishing a mental health program

A third type of consultation consultee centered case consultation
focuses on the consultee rather than on the client or clients with whom
the consultee is having difficulty Hopefully consultee benefits derived
from this approach will be translated into gains for the client as well In
this interaction much of the consultant s time is spent in talking about the
client with the goal of detecting the distortions and omissions m the con
sultees perceptions that account for the difficulty he is experiencing
Once these problems have been identified attempts are made to help the
consultee master his own problem with the case A variety of personal
deficiencies such as inadequate understanding inadequate skill inability
to remain objective or a lack of self confidence may account for the con
sultee s difficulty The consultant is called on to determine the basic prob
ton and to provide whatever is necessary to enable the consultee to be
more effective

The fourth type of consulting relationship, consultee centered admin
istrative consultation has the goal of helping consultees deal with the
problems of setting up and maintaining agencies for treating emotional
disturbance This type of consultation is often directed toward admims
trators as is often true of program centered consultation and this type of
consultant should be a mental health specialist with administrative expe
rience

Consultation practices expand the mental health specialist s sphere of
influence Within the large urban area they have considerable potential
for reaching large numbers of individuals who may never approach a
mental health professional directly A consultants efforts with school
teachers lawyers physicians policemen welfare workers and the like
can have enormous impact on the mental health problems of the people

RECENT COMMUNITY EFFORTS / 273

o£ any community Rieman (1969) has argued that mental health con
sultation is also a particularly effective way to deal with the mental
health problems of the small community In such areas because of the
dearth of mental health professionals, members of the health education
al, or legal professions often must provide necessary mental health serv
ices These "caregivers" need the assistance of trained professionals The
consultation program described by Rieman involved what Caplan has
called program centered administrative consultation The consultant
helped to plan and set up an overall mental health program for a small
urban area Spielberger (1967) has also described a preventive consulta
non service in a rural area In Sp.elberger’s program client centered case
and consultee centered case consultation predominated Groups of phy
sicians, teachers, clergymen, and nurses met with a consultant . in a . case
seminar format and presented specific problem cases to the consultant
who responded with understanding, advice and, at times, sfKClfic realm
mendations Beyond helping with the specific case, the consultant ef
forts were directed toward educating consults with r«pe let ^to the natu
menial he.1,1. £*-> f £

rr. sssss zrrxrss

problems, the lower classes are f , i f on percent of a police

Lip in times of crisis ^

officer’s function is devoted to enforcing laws It is also

problems that are related to ""^" g wlthm f ara ,l,es or among people
found that most serious crime e rs Therefore, Bard feels

who know each other, rather ‘ dlschar ge more effectively the

that it is worthwhile to ,ra > P to „, rtonn m many everyday crisis

service function that they are

situations „ rm ect within a single precinct of

Bard organized a demonstration pi m dudes about 85,000 peo-

New York City responsible for an . 45 volunteers

pie A group of 18 patrolmen iThavioral principles for

for the program and were trained course work , field trips, labora

a one month period by using 0 "“ £ . huraan relations workshops

tory exercises involving role p 5 own values and attitudes

aimed at sensitizing the police o c urf {or a period of about

In its operational phase. Bards ^ manne d by h.s trainees

21 months during which time one ansmg m t h e precinct

was always available £or deaI ”f ka nd as involving family disturbances
All complaints identifiable bef health backup support was

were referred to this particular car Men

274 / prevention programs in the greater community

provided through weekly discussion groups for 6 men at a time and by
one hour weekly consultations with an advanced clinical psychology stu
dent This aspect of the program was mutually beneficial to the police of
ficer who was thus provided with mental health expertise and to the stu
dent who derived from the interaction an opportunity to learn about the
community

The available information on the evaluation of this project (Bard,
1970, Bard 1971) indicates that during the 21 months that it func
tioned, Bards unit intervened in 1375 incidents involving 962 families
Despite the fact that intervention in family crisis situations ordinarily in
volves a relatively high risk of injury to the police officer, not one single
injury was sustained by any member of the consultation program unit
During the same period three patrolmen who were not part of the pro
gram but who worked in the same precinct did sustain injuries while re
sponding to family disturbances Community response to the unit ap-
peared to be very positive as measured by a variety of indirect sources
Although homicides in New York City increased during the project peri
od, there were none within the families dealt with by the unit The num
ber of assaults in the demonstration area was reduced, and the number of
arrests for assault during the project period dropped The apparent sue
cess of this demonstration project has led Bard (1971) to propose that a
program of this kind be extended by developing police specialists to deal
with problem groups such as adolescents and psychotics

CONCLUSION

This chapter provides a sampling of the programs that have emerged in
recent years to deal with the mental health problems of society The few
examples provided of very early community’ programs m urban areas
suggest that recent efforts are far from novel The urban problems of a
large immigrant society, which characterized the United States at the turn
of the century, are in many respects duplicated in modern urban areas
where large numbers of disadvantaged individuals have migrated from
other parts of the country Crime, alcoholism, failure to take advantage
of educational opportunities and the like, typified the late 19th century
urban ghetto as much as it does the urban ghetto of today

What is novel about current community efforts is that they are being
spearheaded by mental health professionals In the past the church, the
sensitive concerned members of the advantaged social classes, or the oc
casional politician were responsible for efforts to improve the lot of the
impoverished and poorly educated Currently the mental health specialist
is becoming involved in the business of dealing with community prob-

REFERENCES / 275

lems and the programs described are m many instances proliferating
throughout the country

Many of these programs involve other than traditional mental health
problems and require other than a traditional role of the mental health
worker Often political action aimed at improving destructive or
growth limiting environments or the reorganization of social structures to
make them more growth facilitating is required Historically workers in
early community programs found it necessary to enter the political arena
more or less directly to promote needed legislation and to struggle for so-
cial change For the mental health professional politics dominated pn
manly by members of the legal profession is a vast wilderness And even
if he is able to find his way around in this wilderness and to achieve some
success he is likely to find that the political model is useful for dealing
with some problems and is entirely ineffective with others that require a

more purely psychological approach

It 15 far too soon to judge which of the programs reviewed will be mos
effective and useful in the long run Hopefully all will undergo | “ re
testing and refinement and will eventually become firmly
entirely new institutions or in many cases drastic modificat ons of o d er
institutions they face an uphill battle Their acceptance wail mewtably
depend on their proven effectiveness as well as a wilhngn P

of society to accept changes More will be said about these issues
chapters that follow

pfprPUPPS

Bard M

American Psychologist 1969 24 610-61 F Korten S W

Bard M Alternatives to traditional law en “ rce ™ problems of society

Cook & J I Lacey (Eds > ZLatJ 1970 Pp 1«W«

Washington D C Americ y h „ ln , ne sys tem Community Mental

Bard M The role of law enforcement in the helping system

Health Journal 1971 7 ISM 60 .oecalists in family exists

Bard M & Berkow.tr B T "^"f 0 ^ actlon program Community Mental
intervention a community p Y

Health Journal 1967 3 315-317 practice Journal 0 f

Bindman A J Mental health consn ration theory

Consulting Psychology 1959 23 New York Basic Books I9M

Caplan C Principles of preventive psy‘ > E 0 careers for the

Fishman J R Denham W H o) a social experiment Washington

disadvantaged in human seTV,e f Youth Studies 1969
D C Howard University Institute .o

276 / prevention programs m the greater community

Fishman, J R , Klein, W L , MacLennan, B W , Mitchell, L , Pearl, A , &
Walker, W Training for new careers Washington, D C Presidents
Committee on Juvenile Delinquency and Youth Crime, 1965
Goldenberg, I I Build me a mountain youth poverty, and the creation of new
settings Cambridge, Mass The MIT Press, 1971
Hallowitz, E, 8c Riessman, F The role of the indigenous nonprofessional in a
community mental health neighborhood service center program American
Journal of Orthopsychiatry, 1967, 37, 766-778
Holden, A C The settlement idea a vision of social justice New York
Macmillan, 1922

Klein W L The training of human service aides In E L Cowen, E A Gardner,
8, M Zax (Eds), Emergent approaches to mental health problems New
York Appleton Century Crofts 1967 Pp 144-161
Levine, M , 8c Levine, A A social history of the helping services New York
Appleton Century Crofts, 1970

MacLennan, B W , Klein, W L , Pearl, A , 8c Fishman, J R Training for new
careers Community Mental Health Journal, 1966, 2, 135-141
McCord, W , McCord, J , 8c Zola, I K Origins of crime a new evaluation of the
Cambridge Somerville youth study New York Columbia University Press,
1959

Pearl, A , 8. Riessman, F New careers for the poor New York Free Press, 1965
Peck, H B , 8 Kaplan, S R A mental health program for the urban multi service
center In M F Shore, & F V Mannino (Eds), Mental health and the
community problems, programs, and strategies New York Behavioral
Publications, 1969 Pp 123-142

Peck, H B , Kaplan, S R , 8 Roman, M Prevention treatment and social action
a strategy of intervention in a disadvantaged urban area American Journal
of Orthopsychiatry, 1966, 36, 57-69

Powers, E, 8 Witmer, H An experiment in the prevention of delinquency New
York Columbia University Press, 1951

Rieman, D W Midway a case study of community organization consultation In
M F Shore, 8 F V Mannino (Eds), Mental health and the community
New York Behavioral Publications, 1969 Pp 41-58
Riessman, F A neighborhood based mental health approach In E L Cowen,
E A Gardner 8 M Zax (Eds), Emergent approaches to mental health
problems New York Appleton Century Crofts, 1967 Pp 162-184
Riessman, F , 8 Popper, H I (Eds) Up from poverty new career ladders for
nonprofesstonals New York Harper 8 Row, 1968
Sarason, I G Verbal learning, modeling, and juvenile delinquency American
Psychologist, 1968, 23, 254-266

Sarason, I G , 8 Ganzer, V J Social influence techniques in clinical and
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REFERENCES / 277

Schwitzgebel, R L Delinquents with tape recorders New Society , 1963, 1, 11-13
Schwitzgebel, R L Streetcorner research Cambridge, Mass Harvard University
Press, 1964

Schwitzgebel, R L Short term operant conditioning of adolescent offenders on
socially relesant variables Journal of Abnormal Psychology, 1967, 7, 134-142
Schwitzgebel, R L , &. Kolb, D A Inducing behaviour change in adolescent
delinquents Behavior Research & Therapy, 1964 , 1 297-304
Slack, C W Experimenter subject psychotherapy a new method of introducing
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238-256

Slack, C W Score— a description In Experiments m culture expansion
Sacramento, Cal California Department of Corrections 1963 Pp 59-64
Spielberger, C D A mental health consultation program in a small community
with limited professional mental health resources In E L Cowen, E A
Gardner, 8. M Zax (Eds ) , Emergent approaches to mental health problems
New York Appleton Century Crofts 1967 Pp 214-236
Stanfield, R D , Maher, B A Clinical and actuarial predictions of juvenile
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1968 Pp 245-270

Zax, M , & Cowen, E L Abnormal psychology changing conceptions New York
Holt, Rinehart & Winston, 1972

io. the creation of growth -
enhancing settings

Each community program we have discussed thus far has been estab
lished within the confines of an ongoing community structure Some pro
grams hive attempted to change the structure to improve the lives of all
community members More often they have been directed toward indi
viduals already manifesting either incipient or blatant signs of behavior
disorder In this chapter we examine actual attempts to create essentially
new socnl structures In some instances the motivation for these ambi
tious endeavors is fueled by utopian or religious ideals m others the mo-
tivation derives from a wish to apply newly developed technology both
psychological and otherwise to establishing living situations that will lead
to an improvement in the quality of man s life
The dream of building an ideal living situation is probably nearly as
old as civilized man Mans earliest conceptions of an afterlife in some
heavenly domain very likely contained in them the seeds for later active
attempts to create ideal living situations here on earth Many literary fig

THE CREATION OF GROWTH ENHANCING SETTINCS / 279

ures, dating back hundreds o£ years, have described plans for ideal or
utopian societies Fairfield (1971) identifies the earliest actual attempt at
establishing a utopian society as that of the Essenes, a solitary group liv
ing on the shores of the Dead Sea, between the second century B c and
the second century a d This was a group of celibate men who worked at
their own particular specialties but who pooled ownership of their prop
erty Members of this Judaic sect lived separately in dwellings scattered
through a number of towns and villages but shared and consumed the
products of their labors collectively Between the 11th and 17th centuries
in Europe a number of other minor religious sects formed communal hv
ing societies, drawn together by the persecution of outsiders, where they
shared ideals and values

In the United States during the 19th century occurred a number of ex
periments in communal living designed to satisfy utopian ideals Kanter
(1972) has identified three forms of dissatisfaction with organized socie
ty that prompt the quest for a utopian community The first concerns the
failure of the typical society to live up to certa.n rehgious ideals Many
who have been drawn to utopian communities lave wis e
others whose religious values comcded with their own and to hare 'here
lives in harmonious coexistence A second source of
lates to the political and economic character of estabhshed .nstnuuon

For examp, e P the 19th century

fact that a large number of -n that

the primary benefit of relatively few narticularly in recent

has caused the development of new ^ $ ' sychosocial character

years centers around unhappiness thealienation and Ioneh

Individuals thus concerned are distresse ^ ^ ^pje are out of

ness experienced in modern socie y ^ ba5tc , nner na ture For

touch with each other and even -ichieiement is rejected in fasor

this reason, society’s heavy emphasis central ideals Man is seen

of "self actualization ’ or "persona gro " „ an( j must be freed io

to need liberation from society s typtea , (b) lus oun thing”

achieve intimacy, psychological growth an , cars 1S a more to-

Another significant social deve 0 P*" corom unuies lo house, in some
ward the planning and creation o -phese planned communities are

instances, literally thousands of peop political, or psychosocial na

inspired less by utopian ideals of a rengi . l ^ aty whlcfl d cselopcd
tore than they are by an awareness unp)an „ed forces, docs not pro-

haphazardly m response to a sari mo( j crn ma n Instead, it is be-

sent the best type of hung Slt “ a ,.ir or ts with respect lo archneclure.
liesed that by combining mans uesi

280 / the creation of growth enhancing settings

various types o£ technology, and sociological and psychological under
standing entirely new communities can be built that will be more com
fortable, healthier, and happier places in which to live than is the city or
town as we know it

We are concerned here, then with both types of new communities, the
utopian society as well as the planned community Each represents an ef
fort to create an optimal living situation Each has the goal of helping
man to grow more strongly and to live more happily than he is able to do
in modern day society

PERSPECTIVES ON COMMUNAL LIVING SITUATIONS

Kanter (1970 1972) has reviewed and compared the experience of a
large number of 19th century utopian communities Her work provides a
valuable backdrop for classifying and understanding the commune move
ment as it is developing today and the problems it faces

Kanter views the utopian community as stemming from a particular set
of ideals concerning man and the possibilities for his living a healthy, re
warding social life The first of these ideals is the notion that human per
fectabihty is possible Most basic to this belief is the idea that whatever
tensions conflicts and disharmonies exist in social situations, they stem
not from man s inner being but are inflicted on him by the social condi
tions m which he must live Thus the creation of a better society will free
him and allow him to live on a higher plane than he had ever known A
second ideal is a tremendous faith m the value of order General society
is seen to be chaotic, purposeless and wasteful m many of its functions,
and it is believed that the carefully planned utopian community can coor
dinate human affairs in such a way that every member’s welfare will be
assured In some of today s communes this value is emphasized through
the title Intentional Community In the utopian community, therefore,
aH events have purpose and contribute toward the group's shared values
t lr significant value in the utopian community is brotherhood
Mans social world is thought to be potentially harmonious with the uni
verse s natural laws and analogously, individuals are thought to be capa
ble of living harmoniously with one another Such harmony is enhanced
by remoung the artificial ' barriers between people that result in compe
tition, jealousy, and conflict and prevent the development of natural rela
uonships Erasing these barriers entails substituting community property
for individual possessions the sharing of necessary work and, perhaps
even the sharing of family and love life

A fourth salue of the utopnn society is the merging of physical and in
tellectuil spiritual pursuits Tlius physical labor holds high status in the

rF.R5P£CTn ES ON COMMUNAL L1VINC SITUATIONS / 281

commune and is even considered to be a basic condition for mental well-
being. In fact, many Utopians have believed that intellectual or spiritual
experiences could only be expressed through bodily states. A fifth value
for builders of utopian societies is experimentation. Since the establish-
ment of the utopian community is itself a drastic experiment, compared
with the usual way people live, a marked predisposition exists for experi-
menting within the community. Consequencely, practices are occasionally
initiated that are illegal in the larger society. This exposes the utopian
community to potential confrontation with law enforcement officials.
Nonetheless, a wide variety of experimental practices are found in utopian
communities; these include dietary experiments, the use of drugs, and the
practice of yoga or astrology. A final value characterizing most utopian
communities is pride in the community's uniqueness and coherence as a
group. Commune members are acutely sensitive to their place in history
and to their own particular boundaries. Unlike people in the larger socie-
ty who are only vaguely aware of who belongs in their social community
in most utopian communities members know precisely who e ongs, w
the community stands for, and how it is different from the outside com-

” Inmany instances the ideals impelling the development of c °““ u ” aI
societies prompt Utopians to return to the land w ere t cy “
a circumscribed area separated from the larger society. There they can
achieve a simpler, more natural life than is f° un in
urban setting. In the farm setting, the necessary

„ Li, „ .ts "fix

vklual talents. The rural living arrangement fostersanideahred ha™

and brotherhood and also helps the group o
and to distiyish itself from the sun-ounjngs^^. ^ com .

Between the Revolutionary and A few were to survive

munities were established in the “ . whne others dissolved in less
many years (one more than Extended period as a criterion of

than a year. By using survival f successful 19th-century utopian

success, Kanter (1972) has compare , with 2 1 unsuccessful com-

communities (surviving, at least, . , (existing for less than 16

munities established during the same pe unsuccessful com-

years) . The difference between t e sue degree to which they are

munity is considered by Kanter to resi members. Commitment is,

capable of building commitments among through which the work

in turn, affected by the organizational' * aJ well as the ideals

necessary to meet both a communi y mun ity gets done. In the long

that prompted the establishment of the commun

282 / the creation of growth enhancing settings

run, therefore, the success of the community demands its members’ com
mitment to necessary work, to the community s basic values, to each oth
er, and to the degree to which members are willing to give up their own
independence when it interferes with group interests Because the utopian
community has separated from a larger social order, there is constant
competition for the loyalty of members between the new community and
the larger society Maintenance of good communal relations requires that
what the person is willing to give up to the group both behaviorally and
emotionally, and what the group requires of him be closely coordinated
and mutually reinforcing

Commitment Mechanisms Characterizing 19th Century Communes

Kanter identifies six processes that built commitment to communal
groups m 19th Century communes They are sacrifice, investment, renun
ciation, communion, mortification, and transcendence

Sacrifice

The process of sacrifice requires the recruit to give something up as his
price for becoming a group member Presumably the more he must give
up, the more valuable will he regard his membership in the group A va
riety of sacrifices were required for membership m 19th century com
“unities Absti nance from alcohol tobacco, coffee, tea, and rich foods
or meat are examples In modern day communes similar sacrifices are
sometimes seen such as the requirement that one abandon drug use or
adopt a vegetarian diet Forms of sacrifice such as sexual abstinence, and
avoidance of personal adornments like jewelry and attractive clothing
were also practiced m the 19th century Yet another was a commitment
to an austere life style devoid of comforts and luxuries One measure of
the austerity of its life was whether the community built its own dwell-
ings Activity of this kind involves considerable struggle and commit
ment, and at its conclusion concrete signs of a communal effort remain
Table 1 compares successful and unsuccessful 19th century communes
with respect to these v anous sacrifice mechanisms

Investment

The individual who makes a heavy investment in the group has a sen
ous stake in its future Such an investment can consist of material that
would make it costly for him to leave the group, but it also can involve
intangibles such as time and energy Thus the utopian community should
not have nonresident members who share in group benefits without being
totally active participants One must be either * in ’ or “out” of the group

Members of successful communes became integrated with the group's
economic system by donating their money to the group, assigning any

rERSPECTlSES OV COMMUNAL LIVING SITUATIONS / 283

Table 1 Proportion of Successful and Unsuccessful 19th Century
Communes Ha\ing Sacrifice Mechanisms at Any Time in
Their History (from Kanter, 1972) *

Sacrifice Mechanism

Successful

Communities

Unsuccessful

Communities

n/A*

Percent

n/W

Percent

Abstinence

Oral abstinence

7/9

78

11/ 20

55

Celibacy

9/9

100

2/21

9

Other abstinence

5/7

71

4/14

28

Austerity

Built own buildings

9/9

100

18/21

83

*N represent* the number of communities for which the presence or absence of the
mechanism was ascertainable n represents the number in which the mechanism was
present

property that they might own to the community, and transferring to the
community anything they earned while members Furthermore, these m
vestments were emphasized by their irretersibihty In many communities
records were not even kept of what was donated by individual members
Also, if a member elected to leave the group, the successful community
rarely reimbursed him for any material things that he had brought into
the group or for what he had contributed by his years of service and la
bor Table 2 compares successful and unsuccessful 19th century com
munes with respect to investment mechanisms

Renunciation

Since relationships outs.de of the group as well as wlthl " f S “ b ™
its threaten to disrupt group commitment an co esion £

munal groups of the 19th century tended to require the «nunc ation of
these diluting influences As a members options for
of the group^decrease the poten

tion within the group increases In the nrocesses can

dependent on the group for all "he couple within the

involve the world outside of the comm

group, and the family i.mired the amount of

Successful 19th century utopian c°—™ s „ch a bamer was

contact with the outside society One ^th-century communal socteties
through geographic isolation M .y or (owns Acc ess to the

were, at least five miles away ® ]ived far from the immediate

community was made difficult and outsiders to- ^ ^

♦For full discussion of the data in fables J > v methods described in the

and Community These data were coec e Rosa beth Moss Kanter, Cfimmif

appendix of the book (Reprinted yp Sociological Perspective "

♦ fnmmumtv Communes and Utopias

284 / the creation oj growth enhancing settings

Table 2 Proportion of Successful and Unsuccessful 19th Century

Communes Having Investment Mechanisms at Any Time in

Their History (from Kanter, 1972)

Successful Unsuccessful

Communities Communities

Investment Mechanism

n/N*

Percert

n/N*

Percent

Physical participation

Nonresident members prohibited

6/7

86

7/17

41

Financial investment

Financial contribution for admission

4/9

44

9/20

45

Property signed over at admission

9/9

100

9/20

Group assigned property received
while member

4/7

57

6/14

43

Irreversibility of investment

No records of contributions

4/8

50

4/14

28

Defectors not reimbursed for
property— official policy

3/7

43

5/12

42

Defectors not reimbursed for
property— in practice

2/6

33

0/6

0

Defectors not reimbursed for
labor— official policy

6/7

86

7/15

54

Defectors not reimbursed for
labor— in practice

6/7

86

S/9

33

*N represents the number of communities for which the presence or absence of die
mechanism was ascertainable n represents the number in which the mechanism was
present

area The community became an entirely self sustaining unit Language
and dress styles became distinctive and served to create boundaries for
separating the community from the outside In successful communities,
movements across their boundaries were carefully controlled so that reg
ular members tended to leave the community less frequently than once a
year Likewise the presence of nonmembers in the community was very
carefully regulated Rules were established to restrict interactions be
tween members and visitors

The regulation of two person intimacy was also regarded as extraordi
narily necessary in successful communities Two-person attachments
particularly those involving sexual attraction were seen to represent sen
ous competition for the devotion of the members energies and loyalties
to the group Thus communities that managed to survive had strict poll
cies about intimacy which were designed to restrain the formation of
dyads Two extremes were commonly practiced at one pole complete
celibacy was enforced, whereas at the other free love, including group
marriage was practiced In the latter case, every group member was ex

PERSPECTIVES ON COMMUNAL LIVING SITUATIONS / 28a

pected to be intimate sexually with every other group member Private
ties were minimized and, in a free love situation, any signs that one par
ticular couple were becoming overly attached to each other were counter
acted by the requirement that each circulate among other group mem
bers

Just as the dyad threatened group cohesion, so did the family Thus m
a high proportion of successful communes families did not live in a single
dwelling as a unit Children were separated from parents often to be
raised in a separate children s residence by community members assigned
to this task Table 3 compares successful and unsuccessful 19th century
communes with respect to various renunciation mechanisms

Table 3 Proportion of Successful and Unsuccessful 19th Century

Communes Having Renunciation Mechanisms at Any Time

in Their History (from Ranter, 1972)

Successful Unsuccessful

Communities Communities

Renunciation Mechanism

nfN* Percent njN'

Percent

Insulation

Ecological separation
Institutional completeness
(medical services provided)
Special term for outside
Outside conceived as evil and
wicked

Uniform worn

Foreign language spoken

Slang jargon other special terms

Outside newspapers ignored

American patriotic holidays ignored

Crossboundary control

Average member rarely leaving
community

Rules for interaction with visitors

Renunciation of couple
Free love or celibacy
Controls on free love celibacy
or sexual relations

Renunciation of family
Parent child separation
Families not sharing a dwelling unit

9/9

7/7

4/7

2/7

8/9

5/9

2/9

3/6

3/4

2/2

3/7

9/9

7/9

100

21/21

100

10/18

57

0/17

28

0/19

89

5/17

56

3/21

22

2/19

50

1/16

75

4/6

100

0/7

43

1/15

100

6/21

78

1/21

48

3/20

33

1/20

0

30

14

29

5

286 / the creation of growth enhancing settings

Communion

The term communion refers to a sense of belonging a sense of being
part of the group as a whole and an immersion of oneself in the group to
the degree that one has an equal opportunity both to contribute and to
benefit The we feeling is strong when a true sense of communion ex
ists and former social ties are completely severed so that one becomes to-
tally absorbed in the community

The feeling of communion was fostered in successful 19th century
communities by several factors One was the homogeneity of the back
ground of many who made up these communities Often they shared a
common religion had similar social or educational roots or were of the
same national or ethnic origin Less successful groups were more hetero-
geneous collections of individuals banding together m response to an 1 m
personal notice such as a newspaper advertisement

Another factor that fostered a sense of communion was the enforced
sharing of all goods and property Generally in the successful community
all property was turned over to the group which owned the land the
buildings the furniture the tools and any equipment used by the com
mumty In some cases even the clothing worn by members was regarded
as community property and was drawn from a common pool with little
regard for sizes or styles

Another factor promoting a sense of communion was the fact that all
group members rotated through all necessary jobs and received equal re
ward for their efforts Specialization was not permitted in most successful
communities where admission was not based on preferences for special
types of skills artistry intelligence or technical knowledge Rotating jobs
had the effect of eliminating the concept of a career among community
members

Another communion fostering technique was the regularization of
group contacts Members were rarely left alone and frequent group
meetings were held requiring the attendance of all members In successful
utopias such meetings might convene as often as once a day Associated
with these structured group contacts was the development in successful
communities of group rituals Many successful utopias emphasized group
singing even writing their own songs Special community occasions were
celebrated for instance significant dates in the community s history
Finally the persecution suffered by many of the 19th century expert
mental communities at the hands of the larger society also was a force for
creating communion among its members Facing a common enemy tend
ed to bind group members together The persecution inflicted on such ex
perimental communities ranged from public denouncement in the news
papers to economic discrimination and at times even to physical force
through mob violence '

Table 4 compares the communion mechanisms characterizing success
ful and unsuccessful experimental communities of the 19th century

Table 4. Proportion of Successful and Unsuccessful 19th Century
Communes Having Communion Mechanisms at Any Time
in Their History (from Kanter, 1972)

Communion Mechanism

Successful

Communities

n/N‘

Unsuccessful

Communities

nfW

Homogeneity

Common religious background
Similar economic and
educational status
Common ethnic background
Prior acquaintance of members

Communal shartng
Property signed over at admission
Group assigned property
received while member
Land owned by community
Buildings owned by community
Furniture, tools equipment
owned by community
Clothing and personal effects
owned by community
Legal title in name of
community (not individuals)

Communal labor
No compensation for labor
No charge for community services
No skills required for admission
Job rotation
Communal work efforts

Regularized group contact
Communal dwellings
Communal dining halls
Little opportunity or place for
privacy

More than two thirds of typical
day spent with other members
Regular group meetings
Daily group meetings

Ritual

Songs about community
Group singing

Special community celebrations

Persecution experience

Violence or economic discrimination

8/9

7/8

6/9

8/8

9/9

4/7

8/9

8/9

8/8

6/9

7/8

8/8

7/7

7/8

3/6

7/7

3/9

5/9

2/9

5/8

9/9

5/9

5/8

7/7

5/6

89

10/20

50

88

10/16

63

67

3/20

15

100

17/20

85

JOO

9/20

45

57

6/14

43

89

16/21

76

89

15/21

71

100

15/19

79

67

5/18

28

88

18/21

83

100

7/17

41

100

9/19

47

88

13/17

77

50

8/18

44

100

7/14

50

33

14/21

67

56

15/19

79

22

2/16

13

63

3/13

23

100

13/16

81

50

1/16

6

63

2/14

14

100

8/11

73

83

5/10

50

63

10/20

50

.hich the presence or absence of the

‘N « prOTt! the n«-*r of ~ ?£££* - “

mechanism was ascertainable «

present

288 / the creation of growth enhancing setttngs

Mortification

The term mortification refers to the destruction of one’s sense of a pri
vate ego m favor of a new identity whose meaningfulness is based on
group membership As a result of mortification, self-esteem derives from
one s commitment to group rather than to personal standards From this
viewpoint, to be worthwhile one must live up to the model offered by the
community The mortification process entails stripping away a person's
earlier identity, making him dependent on authority, and making him in
secure in his role until he has learned what the group expects of him In
religious groups this process is related to a concern with erasing the “sin
of pride Often individuals come to experimental communities precisely
to have their identity changed and may refer to this process by terms oth
er than mortification for example, ‘ personal growth ” Within the com
mumty itself the mortification procedure is felt to be proof of the fact that
the group cares about the individual, about what he thinks and feels
Mechanisms for promoting mortification include confession, self criti
cism and mutual criticism among group members Many successful
19th century communes encouraged the individual to ‘ bare his soul,” to
admit weaknesses, and to confess his imperfections The group was per
nutted to pry into the most intimate matters relating to the individual In
many instances new members were required to confess misconduct en
gaged in before joining the community Not uncommonly these confes
sions were made before the entire group

Public punishment was another mortification process It was, of
course, embarrassing and impressed on each member that his status in
the organization was always in question Publicly visible sanctions were
carried out against deviants from the group in most successful communi
ties

Still another mortification mechanism practiced in successful 19th cen
tury groups was the awarding of status to members on the basis of how
well they were able to live up to group standards and to identify with the
community In a sense this distinguished members on spiritual moral
grounds Those considered to be more spiritual more moral, or more
zealous received greater respect from the group

Finally, the mortification procedure also involved reducing all mem
bers to a single common denominator to encourage group identity The
use of uniform dress styles was one mechanism for achieving this com
monality as, similarly, were communal dwellings and dining halls

Table 5 contrasts successful and unsuccessful 19th century communes
with respect to mortification mechanisms

PERSPECTIVES ON COMMUNAL LIVING SITUATIONS / 289

Table 5 Proportion of Successful and Unsuccessful 19th Century
Communes Having Mortification Mechanisms at Any Time
in Their History (from Kanter, 1972)

Successful Unsuccessful

Communities Communities

Mortification Mechanism

Confession and mutual criticism
Regular confession
Confession upon joining
Mutual criticism or group confession
Mutual surveillance
Surveillance by leaders

Sanctions

Public denouncement of deviants
RemovaI/>f a privilege of
membership

Participation in a community
fpncion prohibited
Deviants punished within community
more often than expelled from it

Spiritual differentiation

Members distinguished on moral
grounds

Formally structured deference
to those of higher moral status
No skill or intelligence distinctions
Instruction in community doctrines
Learning of rules and dictates
required

New members segregated from old
Formal probationary period with
limited privileges for new members

Deindividuation
Uniform worn
Communal dwellings
Communal dining halls
Same meals eaten by all

n/N »

Percent

nfN‘

Percent

4/9

44

0/20

0

4/S

50

0/19

0

4/9

44

3/19

26

2/7

29

0/17

0

in

43

1/17

6

6/9

67

3/16

19

2/8

25

2/16

12

3/8

38

2/15

14

4/6

67

2/5

40

5/9

56

3/20

15

4/9

9/9

3/8

44

100

58

1/20

15/17

2/11

5

88

18

2/8

2/7

25

28

2/11

0/17

18

0

5/8

63

8/15

53

8/9

3/9

5/9

3/7

89

33

5G

43

5/17

14/21

15/19

4/10

SO

67

79

40

*N represents
mechanism was
present.

the number
ascertainable

290 / the creation of growth enhancing settings

Transcendence

The term transcendence refers to man s need to consider himself as a
part of some comforting all-embracing structure along with others who
feel similarly and who recognize his individual existence Kanter points
out that achieving this sense of transcendence requires the feeling that the
community is the repository of great power and meaning To some extent
a feeling of this kind is communicated to group members by a charismat
ic leader Successful 19th century communities tended to invest power in
leaders who possessed awe inspiring qualities Furthermore demands
made on group members were often seen to emanate from a higher prin
ciple or power such as justice the people nature s will or God s will
One way of institutionalizing awe to maximize the sense of transcend
ence was to maximize the distance between the higher level decision
makers and the ordinary members who might participate m making day
to day decisions Another means was to cloak the administrative appara
tus in mystery to encourage moral conviction and absolute obedience
Charismatic leaders were often assumed to possess special sources of
power and to be a link between members and some higher repository of
wisdom To encourage this feeling leaders of successful communities of
ten lived apart from the rest of the community enjoyed privileges not
available to the ordinary membership and were addressed by special ti
ties

Another mechanism for encouraging the sense of transcendence was
the establishment of rigid order over the lives of community members
Most successful communities had fixed daily routines throughout their
history Philosophical guides for behavior were provided Free time and
recreation was programmed in line with the groups ideals In some
groups the program extended all the way to the procedure to be used in
dressing oneself

Another mechanism to enhance transcendence was the requirement
that members undergo a conversion to the ideology of the movement
Most successful 19th century communities require a test of faith before
one could join

Finally transcendence was facilitated by traditions It was an asset
therefore if a particular community could build on a prior organization
of some duration that provided a ready made tradition

Table 6 compares successful and unsuccessful communities with re
spect to transcendence mechanisms

Issues Raised by Ranter’s Study

The first question that might be raised about Ranters study o£ 1 9th
century communal living situations is whether longevity is a proper cnte

PERSPECTIVES ON COMMUNAL LIVING SITUATIONS / 291

Table 6 Proportion of Successful and Unsuccessful 19th Century
Communes Having Transcendence Mechanisms at Any Time
in Their History (from Kanter, 1972)

Transcendence Mechanism

Institutionalized awe ( ideology )
Ideology explained essential
nature of humanity
Ideology a complete, elaborated
philosophical system
Power invested in persons with
special, magical characteristics
Demands legitimated by reference
to a higher principle
Special magical powers imputed
to members

Possession of special powers as
evidence of good standing
Ideology related community to
figures of historical importance
Values formed ultimate
justification for decisions

Institutionalized awe (power and

authority)

Authority hierarchy
Top leaders were founders or were
named or groomed by predecessors
No impeachment or recall privileges
Special leadership prerogatives
Special leadership immunities
Separate, special residence for leaders
Special forms of address for leaders
Irrational basis for decisions

Guidance

Fixed daily routine

Detailed specification of routine

Personal conduct rules (demeanor)

Ideological conversion

Commitment to ideology required
Recruits expected to tale vows
Procedure for choosing members
Prospective members often reject
Tests of faith for community children
to receive adult membership status

Successful Unsuccessful

Communities Communities

n/N'

Percent

n/N ■

Percent

9/9

100

16/19

84

8/9

89

15/20

75

7/9

78

4, 121

20

9/9

100

11/19

58

8/9

89

3/20

J5

6/8

75

2/19

10

8/9

89

5/21

24

6/7

86

7/17

41

4/9

44

8/20

40

9/9

7/8

7/9

5/8

6/8

6/9

4/7

100

88

78

65

75

67

57

10/20

7/12

3/18

5/J8

1/15

2/19

3/20

50

58

16

16

7

10

15

6/6

4/6

5/8

100

67

65

8/15

2/15

6/J9

W

13

31

5/9

7/8

56

88

4/2J

6/21

13/17

19

29

77

6/8

3/5

50

6/11

7/9

78

5/21

21

Tradition

Community derived from prior

organization or organized group 7/9 78 13/21

Prior organization in existence

at least 10 years before 5/9 56 1/21

■N represents the number of communities for which the presence or absence of the
mechanism was ascertainable; n represents the number in which the mechanism was
present.

rion of success. Clearly it is an easy one to measure, which makes it im-
mediately attractive in an area where criteria of success are ordinarily
very complex. Kanter argues that such a criterion for evaluating 19th-
century utopian societies is valid simply on the grounds that the overrid-
ing goal of many of these communities was little more than to exist.
Enormous energies were devoted to simply creating a viable social orga-
nization embodying a particular set of ideals. Another argument for the
validity of such a criterion is that since members had a free choice to join
or leave the experimental communities, the fact that they remained with-
in a given community for a very long time is, at least, an indirect indica-
tion that they were receiving within that society the satisfaction of many
of the needs that had brought them there.

Another very significant aspect of Kanter’s study that merits close con-
sideration is the set of forces leading to the dissolution of these utopian
communities. Even the most successful of the 19th-century communes
eventually were disbanded. The reasons for their dissolution rarely in-
volved an inability to cope with the hardships and problems of communal
life. More generally, the group was unable to cope with the dilemma
posed by longevity itself. Sometimes the ideals that originally inspired the
formation of the community were dissipated by the practical demands of
existence. In other cases it was not possible for a community to adapt to
the demands of a changing environment and still maintain its integrity.
Most communities suffered an erosion of membership because their
founders grew old and the second generation did not stay with the group.
Several factors played a role in the breakup of even successful groups.

Natural Disasters, Financial Problems, and Internal Disagreements
Many unsuccessful 19th-century communes failed because they could
not withstand a variety of problems that more successful communities
managed to overcome. In one case an epidemic of fever led to a com-
mune’s end whereas a long-lasting community survived severe bouts of
malaria. In other cases, fires that caused serious material damage resulted
in an end to utopian experiments. In some instances the pressure from
neighbors forced groups to scatter and leave an area, and the motivation
and energy to regroup was not forthcoming. Successful communes were

PERSPECTIVES OV COMMUNAL LIVING SITUATIONS / 293

often forced to more and jet mamged to maintain their integrity as a
group Among the internal problems leading to the destruction of some
groups were the growth of schisms within the group major dissension
among its members and challenges to established leadership Most prob
lems of this kind were overcome in successful groups without leading to
the community s early demise

The Changing environment

Inevitably environments change and the original members of commu
nal groups grow old Tailure to adapt to environmental change can make
the group obsolescent and lead to its eventual death To survive the
group must find a nay of dealing with the changes that take place in the
external society A variety of options are possible Changes may be ig
nored entirely or efforts may be made to incorporate them Dealing with
change by ignoring it involves the risk that it will not be P°»» bl « “ ‘ “ p
change from® intruding on the group Technological advance for ex^
leading to improved transportation and better communication systems
inevitably threatened the isolation of many Wth centun' u op
mumt.es Ignoring these factors led to much d.scontentmen ™ J & P
members and a failure to deal with them eventually cau^d ^ros o„
the basis for the community The alternative appro** > * f an

incorporate external changes into the group is rd b changing envi
gers The adaptations necessary for accommodatmg »
ronment often drastically alter the y h adual in troduction

the communal base In some instances it led to the ^ mth a

of goods life styles and fashions rom and toward t he individ

tendency to be drawn away from t e com 5urroun ding society Early
ualism and materialism characteristic o (h existed at a time

19th century communities had tie it van g Modernday communes are
when external change was relaU ™ y S ‘“ nd for survlV al must attempt to
confronted by a rapidly changing society ; and
develop techniques for dealing wit

The Problems of Aging Recruitment end Maintaining a Hold

on the Second Generation confronts the utopian

The obvious fact that people F""“ ^ one of severa l ways One is

society with a problem that may of , t s last member From

to decide that the group will no oudasu Th ujne , linlted but it must

this viewpoint the groups C “ 'J population and .he d.fficul

struggle with the problems of a steadily itself The growing m

ties a group of this kind encounters - -a, main ^ bnng out
firmit.es of group members for examp

294 / the creation of growth-enhancing settings

siders into the community to perform the physical tasks necessary to
maintaining life.

If a group wishes to survive beyond the life span of its oldest members,
it has two options: it can attempt to recruit new members, or it must
raise its own children to perpetuate the community. Both approaches pre-
sented difficulties for 19th-century utopias. The Shakers who managed to
survive more than 100 years, despite the fact that they were a celibate
community, recruited new members very actively and sometimes took in
entire families or orphans. Most reports indicate, however, that many of
the children taken in and raised by the community refused to remain in it
when they were old enough to have a free choice. The second generation
simply failed to maintain the commitment to the community that charac-
terized their parents who had entered out of free choice. Apparently they
failed to share the needs drawing their parents into the communal society
and, in many cases, they resented commitments that their parents had
made for them.

Recruiting outsiders for the community poses its own special problems.
Not infrequently recruits were dissident members. Sometimes they chal-
lenged the established leadership of the group. In addition, the recruiting
effort itself can consume much time and energy. Furthermore, often the
social problems that had prompted the group’s original members to band
together were sufficiently mitigated that the life in the utopian community
was in a less favorable position to compete with life outside.

Aging also posed problems for those communities whose survival de-
pended on the leadership of a charismatic founder. Some communities
succeeded in many respects without being able to outlive the death of
their first great leader.

The Conflict Entailed in Trying to Serve Two Facets of
Social Life 1

The twofold aims of the 19th-century utopian communities were to
provide a rich interpersonal experience full of meaning and significant
values while they also fulfilled all of the practical, political, economic,
and physical needs of their members. Because, in some measure, this
combination of aims ,s inherently contradictory the term utopian itself
lias come to connote impracticality.

Kanter indicates that the tension created by the pulls toward the two

n° n , ,ra . :"7 :,SpCC ' ! ° f ,hc comm "nity-s life was a factor in
virtually all of the lflth ccntury communes she studied. Most communes
were not content to exist as simple agricultural societies hot tried also to
produce cnou K h Roods and services to enter into commercial and political
relations will, the lar K cr society. This introduces several problems. To

THE 20TH CENTURY UTOPIAN COMMUNITY / 295

deal with external systems requires an organizational structure reaching
out to the larger society Commercial ventures must be informed about
the environmental system in which they will be dealing Entering into
large scale businesses requires labor often more than can be provided by
commune members alone This means that outsiders must be brought
across the boundaries of the experimental community and the resulting
boundary permeability conflicts with some of the commitment mecha
nisms necessary for maintaining the community s integrity Furthermore
as it becomes easier to pass in and out of the system experts must be in
troduced to run certain facets of the business and their goals will pnmar
lly be the success of the venture rather than the values that promoted the
development of the experimental community in the first place

For many 19th century communes even the successful ones commit
ment could be maintained at its highest level during the building stage
when production and trade with the environment was of secondary im
portance Once the community had managed to establish itself however
commercial and political interchange with the larger society grew in im
portance and eventually conducting business began to superse e an o
conflict with the maintenance of community feeling y t e time even
successful experimental communities had run tieir course mos o
commitment mechanisms had disappeared and mem ers no ong
tamed allegiance to the group
Prosperity and the Decline of the Community

Another problem that romr'buted to the "“cess"

19th century communities was P ara ^ lc h '‘ y d hasten d <, dine not only
Financial prosperity not 0 fan efficient commercial or

because it was associated wlt " the ^ ental]c d but also because a

gamzation and all OE the P r ° b, “ nS * at Who are more interest

prosperous community tended to a ml ]deaIs Furthermore fi

ed in prosperity than in the comm J am md ,viduals and families
nancial prosperity led to competitive -hip

and to a preference for private rather than shared ownership

THE 20TH CENTURY UTOPIAN COMMUNITY

, ... „ mh century particularly those m

The experimental communities o 0 f t he 1950s and 1960s A

the United States are mainly P" enom dose i y parallels those

much older movement and one t ia i Israel The oldest of the

of the 19th century is the ktbbutz -—‘ ^Ln 60 years
Israel, ktbbutzim has been in existence for mo

296 / the creation of growth-enhancing settings

The Israeli Kibbutz

In many respects, the kibbutz, as described by Spiro (1970) , closely
parallels in form as well as in guiding ideals many successful 19th-centu-
ry utopian communities. A kibbutz is usually an isolated agricultural
community with firm boundaries which hold its members tightly within
the fold. It is a community in which physical labor and, particularly, the
most onerous of physical chores, are held in the highest esteem. All prop-
erty is held by the community, with members usually contributing all the
worldly goods they own when they join the group and take from it only
what they need. In some cases even clothing is community property and
members draw what they need from a central supply responsible for a
communal laundering operation. Group members are not encouraged to
have contact with the outside community and relationships with visitors
are limited.

The significance of family structure in the kibbutz community is played
down. In many kibbutzim, children are regarded as children of the com-
munity, and are not raised by their parents but by workers assigned to
such duties in a communal nursery.

In the kibbutz described by Spiro the terms marriage, husband, and
wife are not used because they connote a tie between individuals that
might interfere with ties to the group. Instead, men and women who wish
to live together are regarded as having become a “pair." Instead of ac-
quiring a husband, a woman acquires a “young man" or a “companion."
Likewise the man acquires a “young woman” or a “companion.” Di-
vorces might occur frequently, but they entail few hardships since no le-
gal problems are involved.

In the kibbutz, moral values are indistinguishable from group values.
Maintaining the group and group processes in the kibbutz are regarded as
the highest moral ends toward which anyone can strive. This requires
that the individual subordinate all of his own interests to those of the
group. Furthermore, when individual needs conflict with those of the
group, it is the individual who must give way. This applies equally to vo-
cational interests as well as to ideological values. All of an individual's
motivations are expected to be directed toward promoting the group’s in-
terests. Thus each individual is responsible for the welfare of the kibbutz
as a whole.

Another aspect of this attitude toward the group is that to wish for pri-
vacy is regarded as “queer.” Much more highly valued are group living
and group experiences. The ultimate criterion of whether a kibbutz has
achieved success in its organization is the degree to which it radiates
group spirit.

Eiscnstadt (1967) has discussed recent changes which are taking place

the 20th century utopian community / 297

in the social organization of kibbutzim Some of these changes seem pe
culiar to the situation of the kibbutz m Israel, however, others are remi
niscent of many described in Ranter’s discussion of 19th century Amen
can utopian societies The Israeli kibbutzim enjoyed an elite status at one
time because they fostered the settlement of a yet undeveloped country,
because they formed defensive outposts of the new state, and because
they served an important need by absorbing new immigrants to the coun
try As Israel de\cloped as a nation the significance of the original roles
filled by kibbutzim diminished and to some extent their elite status was
weakened In addition, however, the kibbutzim have experienced eco-
nomic changes that ha\c had significant effects on their organization
A most significant factor in contributing to the change of kibbutz
structure was that through a gradual transition the kibbutz w ic was
once populated almost exclusively by young men and women came to be
made up ma.nly of m.ddle aged fam.ly untts w.th a sprinkling of old
mostly retired people, and youngsters representing the second and ev
third generation of community members Thus the population changed
from a relatnely homogeneous one with respect to * .

widely heterogeneous These changes in the makeup of kibbutz memte
Ship are considered by Eisenstadt to have altered many ttaditional k.b
butz values such as equality, the allocation of f rewards 1 a T C a C ^f" g t t h ° e
the simplicity and modesty of life, the place of manu l labor in the ^social
system, the status of collective production and consumption, and
rect democracy form of government on a h hly unlfo rm

Originally, in the kibbutz goods we ■ member would receive

basis with each member assured that annual budgets of

more than he did By I960 members we P ds from a general
equivalent size which they could “ P “ We , vh J eby individual mem
store Thus individual choices becam P [hey wou]d bve in some

bers could decide for themselves ho ^ other respects

respects and how extravagant they mig t ei ^ once yalued agricul

With respect to productivity, whereas own sa ke, material

ture and manual labor as major en s 0(rnltl0 n a nd to this end
achievement has begun to receive S 10 ™ 1 has been introduced In

greater and greater agricultural , ^ ersi . kibbutz and the profitabd

dustrial ventures have been underta en .-.gnificance to the commum
lty of these enterprises has come to ta e °

^ Along with these changes have “^“'^“^'^o'mCb'cr was s^-
of jobs performed by kibbutz mem e -porkers rotated throug a
posed to be identified with a sing e spe , arose for specialists, an

jobs that needed to be done Eventua ^ j oW j e vel service functions
only those jobs requiring managerial s

298 / the creation of growth enhancing settings

were rotated Eisenstadt reports that, m time, even this distinction began
breaking down Leadership positions, which are still allocated largely by
elections, do rotate, but only among a very small group of members
Likewise, service functions such as kitchen and laundry work, work in
the general store and m the children’s house are more and more falling
to the same people for increasing periods of time
With the economic expansion of many of the kibbutzim, another prob
lem involving the hiring of outside labor has been introduced Formerly,
this practice was strictly forbidden by kibbutz ideology Economic expan
sion, however, resulted in a constant shortage of labor, so that hired help
had to be brought in from the surrounding areas

The sheer physical growth of the kibbutz has made it necessary to
abandon the “general assembly ’ form of government which typified its
early days Decision making has fallen into the hands of specialists and
elected officials, with the general assembly now functioning mainly as a
forum for receiving information and for communicating ideas

Early attempts by the kibbutz to diminish the role of the family in the
social structure have also been reversed It was originally expected that a
weakening of the family structure would cause the second generation to
identify more closely with the collective than with the family unit This,
according to Eisenstadt, has not turned out to be the case, with more and
more kibbutzim finding new functions and values in family life Children
seem closer to parents than they once were, and although they still do not
sleep at home in a family unit, a family spirit is clearly present, and fami
lies arc increasingly coming together for meals and other private occa
sions

All kibbutz children receive a similar education and all complete high
school regardless of their special talents The best students are sent on for
higher education outside of the kibbutz with the hope that they will re
turn to the community to become teachers Eisenstadt reports that, on the
whole, the second generation has remained faithful to the kibbutz move
ment and its ideals There arc some notable exceptions, however Many
of the >ounger generation prefer to organize their own kibbutzim in line
with their own pioneering values Others abandon the kibbutz in favor of
cit> life because of conflicts with kibbutz ideals or with their parents In
some instances the) leave to seek a higher standard of life and the possi
bilitv of a specialized career

It is difficult to predict what the eventual fateof the kibbutz movement in
Israel will lie Clcarl) these experimental communities served a vital role
in the growth of the countiy md in the lives of those who elected to join
them It docs appear, however, tint, in Kanter’s terms, the commitment
mechanisms are weakening and the boundaries between the kibbutz and
the larger socict) arc becoming more permeable Although from Kanter’s

THE 20TH CENTURY UTOPIAN COMMUNITY / 299

viewpoint, many of the kibbutzim are successful communities they are
displaying many of the weaknesses that led to the demise of even the
most successful of the 19th century communes

Modern-Day Communes in the United States

Kanter finds many parallels between 19th century social circumstances
which prompted the development of utopian communities and the 20th
century situation which is again impelling many to seek new forms of so
cial life Widespread social movements are appearing that are concerned
with issues similar to both periods women, blacks and even temperance,
although in the latter case it is with respect to drugs rather than alcohol
Similar dissatisfactions are expressed concerning the capitalistic economic
system m both periods In both periods anarchists resistant to any form
of social structure, and spiritualists obeying their mess.ah s commands
have been prominent Just as in the 19th century, large numbers of peo
pie wander from one commune to another And m both period*
cern with individual fulfillment, which tends to lie at the bottom of
form impulses, has been expressed th t t u e

A major difference between the two periods m X-

19th century the concern with ful , fil '““' gOthlntury this concern finds
terms, for example as salvation In J ^ J ldeal social living
expression in psychological terms * ^ h „ or the opportu

situation is concerned now abou t his pe ^ ^ dlfferencc &

nity to “do his own thing This . oresent day utopian is

tween the two periods The major .“"“In with soaal reform, sweeping
with his own personal growth rat we i fare 0 f the community

political and economic change, ® r theme has lc d to the appear

This emphasis on the personal are nonulo pian in character Instead
ance of a number of communes th share d interpersonal rela

they are living situations m whic p Kanter points out that

tionships are close, but an ideo ogy ^ an ex tended family than

these collections of people represent m ^ t | |e contemporary com

they do a utopian community In man ^ making do ’ during a par
mune is a temporary living situation a ' Derma nent social structure
ticular phase of a person's life, rat y a long range wsion of an

In such communities behavior is not , Hime feel for the quality
ideal form of existence but, instead by comnu , nines is measured in

of life at the moment Thus success in the rather than by

terms of immediate personal fulfillment

< . ... I.icfnrv

terms of immediate p ci3UU “

group cohesiveness and endurance building on a sense of history

Instead of looking toward the ^"commune dweller looks to a te-
as did the 19th century utopian to 5 p, cme to be gained from

manticized past and prefers to igo°

300 / the creation of growth-enhancing settings

the broad sweep of historical movement. There is nostalgia for the small
town, for the simple life, for the crafts of the rural societies, for natural
foods, and for dress styles, hair styles, and even the tools and equipment
of an earlier age. Along with this is a yearning to return to the innocence
and simplicity of a childhood free of obligations.

Although these characterizations do typify the majority of present-day
communes, a few attempt to continue the utopian tradition. Some are or-
ganized around charismatic leaders of a religious stripe. Still others are
dedicated to serving a vital need of society.

Whether the communes of today strive to create a utopian society or
merely a temporary family, they face similar problems in establishing a
group. In many respects, these problems are more difficult than they were
for 19th-century community builders because boundaries are not easily
maintained. In the 19th century, physical boundaries could be readily set
up. Isolation was easily accomplished, and since technological needs were
slight, contact with the outside world could be minimized. Life in the
19th century offered fewer options ranging all the way from the choice of
a career to the choice of a life-style. The environment of the 20th century
constantly intrudes, forcing its way through the border of groups. Com-
munication is instant, more people wish to remain in cities to enjoy the
advantages of urban life, and advanced technology diminishes the likeli-
hood that any single group can become entirely self-sufficient, or can de-
velop an economic base making it a complete production unit. New ideas
and stimuli constantly disrupt the establishment of a distinctive set of be-
liefs. Casting about for a new way to determine boundaries, most groups
seem to have settled on either affirmative or negative principles for
boundary establishment. Affirmative principles define the group by what
it accepts; negative principles define it by what it rejects.

On the basis of these two principles, Kanter has created two broad
classifications of modern-day communes. Those whose boundaries are
based on negative principles she calls •'retreat” communes. These are
small groups, anarchistic in nature, that tend to dissolve easily. While
some ur >an communes fall into this class, most are rural groups involving
>oung mem >ers. The goals of "retreat” communes are limited to inter-
personal relationships, and they tend to be very permissive, inclusive, and
temporary. Communes having affirmative boundaries choose to interact
more broadly with the wider society through sen-ice. Their boundaries
arc erected around a "mission," and they may be either urban or rural
and usually have a strong core group that holds the community together.

Retreat communes tend to be isolated geographically, avoid technolog-
, * t,va . nfC - and tIuc!1 on a nostalgic view of an idyllic past. Its mcm-
!>ers live in remote locations, often without modern plumbing or electricity,
and purposely seek a primitive life-style. Many "hip” communes de-

THE 20TH CENTURY UTOPIAN COMMUNITY / 301

scribed by Fairfield (1972) are examples of retreat communes Members
of those groups reject organization, the use of work schedules, and even
the necessity to earn money Material needs are met by relatives, welfare,
or whatever is brought in by new members The events of the outside
world are ignored as much as possible This anarchistic character of the
retreat commune defines the group largely by what it rejects and is not
conducive to building a strong community Having rejected the forces in
the larger society that make for order, the retreat commune cannot hope
to have a strong committed, stable group without introducing an aherna
live type of order Although these groups may provide some individuals
with rich and satisfying experiences for limited periods of time, they have
considerable difficulty in enduring j

Groups established on the basis of affirmative princip es
toward serving a need of society In marked contrast to the t retreat ^com
mune, the missionary commune seeks out involvement with and
often settles in cities In further contrast to retreat groups < he*
erect firm boundaries that encourage group coherence -d^evin ^
strong commitment in their memb I h are already dem

values of the collective are maximized ana sucn g p

leges as Oberlm and ^““^“anT^ern communes have organized
utopian communities Similarly, ma J raJ of them have grown

themselves as schools of one type or a regard themselves as

out of the human potential ™ ov ™ e " y of human relations Some of
“gr° wth centers or centers for t Zen macro biotic lifestyle,

these centers concentrate on ,eac “" g for the mentally handicapped or
whereas others are dedicated to < g ce comrnU nes are made up

to rehabilitating drug addicts Typi • having a deep personal

of two types of membership ( ) , responsibility for teaching

commitment to the community w ic limited involvement, which

functions and (2) a transient ff r0 ' a P*

is expected to move m and out of t ie g 1 £ „[ ,h e service communes

Perhaps one of the strongest Ik n hM ^ to mch.de

is Synanon From its founding m '» ' ’ unIt ,es in California, Ive"

over 1200 resident members in urban an i y a form of group

York, and Puerto Rtco When founded .. was ^ add It ,,as
therapy and a residential treatment set. g ^ jchools am l business-

therapy
evolved into an in

es.dent.al treatment setting an d business-

nentional community with*

es including gas stations and an a ^ ert ‘ may he classed among groups
Twentieth century utop.au "" "“^knovvn ...op, an sociel, of
having affirmative principles *-*£*£1 m the Virginia countryside
tins kind is Twin Oaks, which was

S02 / the creation of growth-enhancing settings

in 1967 (Kinkade, 1973) . The inspiration for this community came from
the utopian novel, Walden II, by B. F. Skinner (Skinner, 1948) . The so-
ciety described by Skinner was based entirely on the behavioral principles
that he had helped to develop in a variety of laboratory studies. Kin-
kade’s account of the development of aspects of the social organization of
Twin Oaks describes attempts to incorporate Skinner’s principles into the
functioning of the community. Her account is also an excellent record of
the practical problems to be faced in arriving at an organization suitable
for such a social experiment. For example, at Twin Oaks efforts were
made to set up work assignments taking into account the desirability of
each job for each individual member. Another problem concerned how to
deal with those who did not wish to do necessary community work, or
who wished to devote most of their time to highly personal pursuits such
as writing poetry. Efforts were also made to equalize the income of indi-
vidual members. Unlike 19th-century communes. Twin Oaks members
were not required to give up their own financial resources on entering the
community. Initially it was decided that any money a person had before
he entered the community would stay in his own bank account with the
community benefiting only from interest and dividends. After a three-
year period this policy was to be reviewed.

The authority structure in Twin Oaks has remained a relatively loose
one. Individuals are named as managers for various work areas. Overall
decision making falls to the group of managers. Basic principles for run-
ning the community are taken from Walden II and attempts are made to
stick with these as long as they seem to be empirically useful. As they
seem to fail in a specific situation, they have been modified. Kinkade jus-
tifies these departures from Skinnerian principles on the grounds that, in
many respects, Twin Oaks is a long way from the relatively ideal situa-
tion envisioned in Walden II. The physical plant at Twin Oaks is a mod-
est one and per capita income is as yet low. Neither has the commune
reached the point where every member does what he ought to do because
that is what lie wants to do. Such a situation is the goal toward which the
Twin Oaks founders are striving, but they still find it necessary to use
other governmental props such as rules and pep talks as substitutes for
intrinsically natural reinforcers.

One problem with which the Twin Oaks commune has had much diffi-
cult) is the legitimate criticism of members’ behavior. Eschewing the
group criticisms that were practiced in many successful 19th-century
communes and even in such modern groups as Synanon, the rule that
eventually evolved at Twin Oaks was that if one was dissatisfied with die
ljcliavior of another, one had to discuss it with him privately. Prior to ar-
riving at this rule, however, several other techniques were attempted,
each of which achieved only partial success. At first a “generalized bas-

the 20th century utopian community / 303

tarcl” was appointed whose job was to collect complaints about other
members and to relay them anonymously. Unfortunately, the person des-
ignated as the “generalized bastard" found that he had little stomach for
Che job. A later variant of this process involved the use of a "bitch box”
in which written grievances could be placed by those without the courage
to confront an offender. The latter technique was found to be successful
with some members but not with others who were little moved by such
complaints. Efforts to apply group criticism also foundered, primarily -
cause those who were most subject to criticsm often refused to attend
group meetings. Since the community was loath to abndge anyon nght
to stay away from meetings that he didn’t care to attend, those volunteer-
ing for criticism tended to be the ones no one was angry with

Marriace at Twin Oaks is a somewhat less stable institution than in the
larger communTty. This occurs, not surprisingly " *“^e am
economic ties to force a couple j° “variety of coupling relation-

pears to be some experimentation nrivate thins at

rilips. Essentially, however, lovemaking is regarded as a private thing

Twin Oaks, and little public affection is seem lhe prob lem of

Thus far, the Twin Oaks C ° m ™^ ted that the first children will be
dealing with a new generation. It » - P 6 . outsiders with children

born in Twin Oaks during 1973. In ** ”* a ' or tw0 old. It has been
will not be accepted until the chi beforc \ he community will be pre-
felt that three conditions must be sufficient resources to

pared to deal with children. These enough stabili-

build a nursery building separate rom a , the same caretakers

ty in membership so that babies W1 ' o£ arent s sufficiently commit-
through their early years; and (3) a gr p r likely to leave,

ted to the ideals of the community so that they

. • rrowth Enhancing
Reflections on Utopian Cotnmumties as Growth

Situations .....

The basic idea behind ^ IbOM u*.

live to the notion that social prob on j y emerge i£ each tndi-

Instead of assuming that a healthy «* ty ion sugge sts that structural
vidual in that society is cured, the » °P »» n ^ ^ ^ , social world
reform must take place within the can no )onge r appear. Thus s
must be built in which the old proM o£ de£ect5 within society

cial problems are considere to . f : a i institutions. .

that can only be solved by reshaping soc. o£ dcdica ,ed imliv.duab

The prospect of starting ™fJ/ 0 Jer-one designed to fuffill

who are devoted to creating a n 1)rD l,l, r ms arising in or inary
important needs and to minimize

304 / the creation of growth enhancing settings

—is extraordinarily attractive The experience of literally hundreds of
these ventures however, m both the 19th and 20th centuries suggests that
this approach is deceptively simple Literally hundreds of well meaning
people have made gallant efforts to organize themselves into social
groups in which healthy, satisfying lives can be lived, only to find severe
limitations within the structures they have formed As Kanter states

" The life of communes, therefore, like other groups, has its limits and
costs as well as its benefits and advantages Utopian communities are not
the answer to everything They are difficult to create, even more difficult
to sustain They exact a dedication and an involvement that many people
find unappealtng They sometimes have shortcomings that make them fail
of the perfection they promise But as thoughtful, concerned people have
discovered, they do supply partial answers ” ( Kanter , 1972, p 235)

Even the long lived, successful communes of the 19 th century seem to
have provided sufficient satisfaction for large groups of members for only
limited periods of time Hence it appears that utopian groups met the
very special needs of many of their original members over an extended
period of time but that these needs were not duplicated m others who
were drawn to the group or in the young who grew up in the utopian so-
ciety For this reason the group eventually disbanded The same seems to
be occurring in most modern communes
Fairfield (1971) is optimistic about the value of 20th century com
munes He rejects longevity or survival as a valid measure of a com
mune s success Instead, he looks to the individual member’s experience
of a feeling of aliveness, a better awareness of himself and others, as a
proper measure of the worth of a communal experience From this point
of view he believes that the present day commune in America has been
\ery successful He views the commune as being in the forefront of a rev
olution that carries people out of a private, intolerable, grasping, solitary
self toward the cooperative, sharing loving universal self ’

Fairfield lists five basic ideals of the commune movement that have im
portant value for society as a whole These include (1) encouraging re
turn to what is real and essential in life, (2) taking man away from the
polluted city and getting him back to his natural habitat where the air is
fresh and he can till the soil, (3) escaping from the alienation that sepa
rates people m our society and bringing them back to shared human rela
tionsmps (1) allowing individuals to self actualize, to find out as much
as they can about their own potential, and (5) providing an example for
the rest of society of how to live a better life

On the other hand even Fairfield is cognizant of the problems encoun
tcred in recent jears in establishing stable communities In large measure
he accounts for these problems as deriving from the fact that Utopians, as

THE 20nt CENTURY UTOPIAN COMMUNITY / 305

products of a competiti\e, o\ crly intellectuahzed society are themselves
"o\ crly cerebral ” He finds the great idea or ideal as often being meaning
less and possibly personally harmful He illustrates this with the example
of a personal experience

"To give another example, at a 4th o/ July party given by a commum
ty group in Boston, I noticed a friend of mine sitting in a corner, looking
quite sad Sad, he was, amid demonstrations in Hatha Yoga, animated
conversations, wild dancing, a great variety of delicious food, good
dunks, and even fireworks-a really great parly 1 couldnt imagine what
was wrong, so I asked him He replied, ‘Sure, tfs a good party, 1 guess
But we’re not getting any closer to the community we want his way He
was utterly convinced that a community had to be a pa, mcularpacew
a particular kind of behavior, so that he was unable to en,oy he preset
He allowed Ins ideals to stand in •*'***???£ ° f
planned, unexpected pleasures of life ( airfie , , p

Fairfield’s example is intended

is possible even in the midst of the g h , but sympathize

’’really great party ” On the other handle ^Ire X^ng re
with the sad friend who may hav transitory nature of the com

lationship to feel a sense of common y socia[ organizations are

munes that Fairfield describes sugges s Th meet t he spe

extraordinarily limned ,n what they can £«* They » 7^ ^ ^
cialized needs of a few individi ca „ serve OV er a long pull

they are not examples 0[ nvtng situanons that £or in „macy,

It is dtfficult to envision, too to* Instead, hke the par

deep personal understanding an only an iramc diate high, tem

ty Fairfield describes, they seem to provt

porary "lacks " pessimism concerning our present

In the light of this survey. Sarason pc we) , founded (Sarason,

capacity for developing utopian ence demonstrates that no

1972) Sarason points out that man baslc valueS| and no matter

matter how firmly a group may s ia nlte m forming a lasting, re

how well motivated its members may t-e ^ budd enduring so-

warding social organization, sue 1 gro iaatlon! 0 £ this kind are to e

cieties Sufficient knowledge as to h | arason fee ls that social relation
created simply has not been '™ J dl5 tances to go before he wt c
ships are so complex that man has » situation Thus Sar

able to thmk about desigmng an optimal oca J ^ ffls

ason’s own efforts are devoted that go toward making up
volved in creating the mint social organ.za

soaeties ot

an entire society results of the utopian

Perhaps because o£ the discouragmg resu

306 / the creation of growth enhancing settings

the past today s experimental communities seem to start out with less of
a sense of mission of grand scope concerning the possibility of sweeping
the entire society than was true m earlier times The typical modern com
mune tends to be a small modest venture tailored to the needs of a par
ticular group of individuals caring little about long range endurance
Kanter points out that the grand visions of the past have been taken
over in the present day by real estate developers and city planners While
somewhat less grandiose than the utopian society builders the city plan
ners wish to create large communities even cities whose basic design can
anticipate human needs minimize stresses and enhance the general qual
lty of life

PLANNED COMMUNITIES

Lemhau (1969) a psychiatrist has described his participation in plan
mng a new town Columbia Maryland which is being designed and built
to house more than 100 000 people Along with a pediatrician a biome
trician a health insurance expert a health educator a health economist
a social work educator a specialist m chronic diseases a public health
dentist an obstetrician a public health administrator a hospital service
analyst and a medical sociologist he participated as a member of a
Health and Welfare group to consider the way the physical structure of
the community might contribute to the health of its members in the
broadest sense

Although as social scientists this group was given an unparalleled op-
portunity to embark on an extraordinarily exciting venture in social plan
mng the first problem that they struggled with was a political-ethical one
concerning the degree to which they had the right to plan the lives of oth
cr people who would one day live m the town that they were helping to
establish How to a\oid restricting freedom and maximizing the oppor
tunny to grow wns felt as an enormous responsibility Since the communi
t> "-as to encompass a full range of socioeconomic classes the problem
arose of how to intermingle very expensive housing with relatively mex
pensive housing without creating ghettoes High value was placed on the
availability of comprehensive health services tor all residents of the
planned community hut the question ot whether a tax should be imposed
to provide these services even Tor those who did not want to have them
iiau to be considered

A major issue quickly agreed on by the consultants participating with

r "i U " 1! llm onc ot thc m1 J or drawbacks of the large city is its lack
of the community feeling tint typir.es small towns The city is simply loo
large and too disparate to allow for thc development of a concern for the
totality Onc can acquire a sense of pride about a neighborhood or a

PLANNED COMMUNITIES / 307

smaller social unit, but not for a very large complex unit such as a city.
This concern led to the conclusion that Columbia should be organized in
such a way that identification might be fostered with small local geographi-
cal units. In planning the size of these units, a number of practical matters
had to be considered. To support a small shopping center, for example,
approximately 10,000 or 15,000 people are required. Such a number also
is capable of supplying enough junior high school pupils to populate opti-
mally sized schools. Thus the range of 10,000 to 15,000 population was
set up as the ideal for a fairly self-sustaining social unit dial would in-
clude various services, a recreation area, churches, and the like.

To accommodate those preferring to live in a downtown ; area ra her
than in suburbs, it was deemed necessary to plan a central at? _comts ting
of high-rise buildings and some of the population density a "“ustle t
typifies the core of a large city. Many community ™“uld be cen
tralized within such an area, and thought was given to £oste ""f 3
bia-wide identification with the city through

structure. Eventually, the : Wea ^ of ^ j educational, pro-

centraI “ re

would be factors with which all neig or . bout t j, e need for

Much of the planning residents would be

adult education. 'While it was ant p hoped that

working in the nearby Baltimore or Washmgmn area^^ ^

the city would eventually attract ig mieht well require training

proportion of local residents. Such industry might q

programs and facilities for retrainings or a! , hough it was not

Welfare planning co " sld< ^ d insurance" plans were rec-

elaborated in great detail. Vario so t j, a t emergencies arising

ommended as part of the financing strain the capacities of

through death or prolonged disability wouWno^s^^^ ^ ^ fonn of
families to support their housing nee ^ by mental health plan-

stress in time of serious emergencies \ recognized that through

ners as extraordinarily important. wqu]( j soon build. Thus plan-

death and disability the city’s weliare welfare system,

ners anticipated a need for expanding the menta! health and to
Several other plans were introdu P These inc Iuded a parent

prevent the development of beha™r tool ut< ir ^ ^ hool

education program in child ■ de ' e °F ' . „ an( J as a basic aspect of pro-
program, as a segment in adult e ' en ’ [al aspect of educational p an-
grams in maternal child care. A psychiatric consultation ‘

ning included counseling backed up > P ’ dosely with med cal

necessary. Local public >'«'«>' ^“ de ^^infonna.io.i. Medical
practitioners, were to be used to prow

308 / the creation of growth-enhancing settings

buildings that would include local health department representatives were
to be placed close to schools to facilitate communication between such
service givers and the school system. Prenatal care plans were introduced
to anticipate physical problems in the newborn. The needs of adolescents
were provided for with the development of suitable recreation opportuni-
ties and the development of part-time employment possibilities. Various
part-time volunteer services for housewives were also planned.

Lemkau was careful to point out that all plans engaged in at Colum-
bia, while prophylactic with respect to some disorders, could not be ex-
pected to succeed in erasing mental disorder. Mental retardation and oth-
er handicaps among children would doubtless appear in Columbia despite
every preventive effort being made. Some of the elderly, while benefiting
to a degree from the provisions made for them, would become senile and
require special care. There is little evidence to indicate that engineering a
particularly healthy environment has an effect on the rate of the occur-
ence of schizophrenia. Furthermore, depression is a disorder that may be
more common among the types of people who would live and grow up in
Columbia than among an unselected population. Lemkau points out that
depression arises more frequently in those who bear responsibilities well.
To the extent that the Columbia environment fosters the development of
a responsible, concerned citizen, depression may commonly be found
among its residents in reaction to the grief instilled by the loss of old
friends as well as by the stresses involved in making new adaptations. Fi-
nally, Lemkau points out that all consultants who participated in plan-
ning the Columbia community recognized that they were making their
best guesses on the basis of experience and information assimilated in a
myriad of ways. On the basis of this unsystematic accumulation of knowl-
edge, they were forced to take action and to plan approaches depending
only on subjective judgments. Not having the assurance the scientist
would like to have on the basis of controlled study that his recommenda-
tions arc likely to be highly effective, Lemkau points out that in the
group in which he participated “one sat as an expert and hoped that he

Nunn (1971) has described a plan drawn up at the Urban Study Cen-
ter of the University of Louisville for dealing with the poverty problems
of this country through the design of new communities. In essence, the
Louisville group drew up a prototype of a plan for designing and popu-
lating new communities that could be applied in a variety of areas
throughout the country. They envisioned that these communities would
Ik located just outside of medium-sized urban areas that are growing eco-
nomically. Many such regions arc impeded in their growth because of a
lack of appropriate labor. Thus the new communities would be a source

PLANNED COMMUNITIES / 309

of manpower for developing urban areas and would provide needed work
for people presently living in places where they cannot find it
A major purpose of this plan is to redistribute the country’s population
so that needy segments can settle in areas where their needs for employ
ment and a better life can be satisfied The Louisville planners envision
that the new communities would consist of approximately 20 000 families
(80,000 people) They estimate that such communities would cost ap-
proximately half a billion dollars to finance but that private sources could
manage this with no more than normal federal backstopping e pan
would require that approximately half of the families to popu ate t e new
communities would be the urban poor who would voluntarily decide to
move and would be assisted in joining the new community The attraction
for these settlers would be an improved living situation and job opportu
nities Such community residents would be prepare or speci c jo
would be oriented toward ‘ the world of work” and the kind
could expect to lead m the new community as responsible, taxpaying cm
zens ThiT remaining settlers would be families not requiring asst: s ame
They would be drmvn to the community because of the ava^bd.^ of
managerial and administrate positions Nf any would be peop e a e y
living ,n the area who would be simply attracted by the prospect living

in a new, planned community t [he Loulsvl lle plan is to

Similar to the Columbia plan, one . p j n some me asure,

avoid creating a senes of ''P overty ttlers who had previously lived

this would be avoided by the fact tlia would j*. trained for

on a poverty level would not remain p different from that

work and placed in rewarding jobs eat ing the development of

expenenced in the ghetto Another mean o avmdmg var

a ghetto would be a deliberate mixing of the popu.

ious social, economic, and racial groups j, as been the develoj>

Among the concerns of the Louisville : p annen ^ (()

ment of a psychosocial environment ^ attention is paid to the dis

growth and a good life In the F ' vanous subgroups within it The

tribution of the population and during any given period

psychosocial planners specify for * " t jJ 3 5 percent of the

m the development of a new comm ’ y assistance m establishing
population should consist of fami > ^neighborhood level residents

their residency Recognizing that a „ homogeneous clusters, it is

might well wish to live in socioecono * 25 dwelhn g units of simi

recommended that clusters consisting duce socioeconomic homo-

lar cost be set up within neighbor 100 con sistmg of eight clusters or

geneity Within a given nel S hb ° r ’° d ch vl Jlage, consisting of six or ses

about 200 dwelling units, and » .dun eacn

503 I the creation of growth-enhancing settings

buildings that would include local health department representatives were
to be placed close to schools to facilitate communication between such
service givers and the school system. Prenatal care plans were introduced
to anticipate physical problems in the newborn. The needs of adolescents

were provided for with the development of suitable recreation opportuni-
ties and the development of part-time employment possibilities. Various
part-time volunteer services for housewives were also planned.

Lemkau was careful to point out that all plans engaged in at Colum-
bia, while prophylactic with respect to some disorders, could not be ex-
pected to succeed in erasing mental disorder. Mental retardation and oth-
er handicaps among children would doubtless appear in Columbia despite
every preventive effort being made. Some of the elderly, while benefiting
to a degree from the provisions made for them, would become senile and
require special care There is little evidence to indicate that engineering a
particularly healthy environment has an effect on the rate of the occur-

ence of schizophrenia. Furthermore, depression is a disorder that may be
more common among the types of people who would live and grow up in
Columbia than among an unselected population. Lemkau points out that
depression arises more frequently in those who bear responsibilities well.
To the extent that the Columbia environment fosters the development of
a responsible, concerned citizen, depression may commonly be found
among its residents in reaction to the grief instilled by the loss of old
friends as well as by the stresses involved in making new adaptations. Fi-
nally, Lemkau points out that all consultants who participated in plan-
ning the Columbia community recognized that they were making their
best guesses on the basis of experience and information assimilated in a
myriad of ways. On the basis of this unsystematic accumulation of knowl-
nnlv l hCy { ° TCC - d !° t3ke aCti ° n and to P lan approaches depending

would HI#*'# U ^ menl . s ^ ot having the assurance the scientist

tinm 'Vi a ' C ^ baS ' S ° E contr °bed study that his recommenda-

CTO n -n /° ? My efrectivc * Lemkau points out that in the
group in ulud. he participated “one sat as an expert and hoped that he

.cr N ot n .hc (1 Uni^M dC ,T bCd n p!an dra " n “P at the Urban Study Cen-

ot this country thro’ug ^ P ° Ver ‘ y P robk ”'
Loumillc prm.n dr/.,. . ^ f immunities. In essence, the

zrx; 1 : * p, ri OT an(, f pop r;

bCt ° ( • lppr ' ,pria " T",.s the ness- comntuniticfs^uid^e aTource

CONCLUSION / Sll

In 19th-century utopian communities, enormous value was vested
in the group, the cohesiveness of members, and a devotion to group stand-
ards. At that time, it was felt that the ideals of individual members could
best be served through developing an overall community spirit. For the
most part, the 20th-century commune is less oriented toward the va ues
of the group. Instead, individual development and satisfaction of the psy-
chological needs of the individual member receive the greatest emp asis.

Another form of social experiment arising in the 20th century is
planned community. In the forefront of this deve opment are e
tect, the urban planner, and the real estate deve oper rat a ^
rial scientist. Basic to the thinking behind the p toned common tyis to
satisfaction with tire quality of life in the Community

structure arise haphazardly over a . iki ut tow ard' radical so-

planners are not so bold as the Utopians m g ^ desigI1 i iv .

dal experimentation, hut they are S u “ e emphasis is on or-

ing situations for literally thousands of Nation groups, in

gamzing the subunits within the city, i planning for the

arranging for the availability of neede ' planning for all these

recreational and work needs of residents. Careful^an ® ' lity ot life
aspects of human life is seen to be a way °f ‘“P r °" stances,
and of preventing the development of c ; ^ - soc j a i living situa-

Although the prospect of starting res a rev iew of the proc-

tions is enormously exciting for the socia £s that t h e y have failed

ess of these experiments and their outcome i : situation. Neither the

to provide a model for a truly , century nor the Israeli kib-

long-lived utopian communities o t e demonstrated to be en-

butzim, which have existed for many ye ’ . can accommodate the
during models of an ideal living Sltu ^* pn dure, many of these groups
needs of a heterogeneous population. . ms t h a t virtually rule out

were required to adopt commitment m While such a living situation
any sense of individuality in their .. j e desire to build a persona

might have sufficed for a person who h* jt was clearly not a

career or to develop any specialize P - own thing." Ev( ; n 1 e . ons

home for the person who wishe to underwent changes in socia or
est-lived utopian experiments OTe . n ‘ u V ; fro m contact with the outside
ganization because of contaminant) - jy. J n many instances,

society, and they eventually dissolved entirj^ ^ origina , found to.
communities did not seem to be a rare ]y dedicated to group va
The typical 20th-century commune is ^ It allows much person-
and tends to require little sacrifice 0 f tion of personal nee s. i
. al expression and a striving toward " uIts in those settings appears

other hand, the social organization

310 / the creation of growth enhancing settings

en neighborhoods and approximately 1200 dwelling units the plan calls
for a variation m clusters to achieve population heterogeneity It is fur
ther stipulated that no cluster neighborhood or village be permitted to
consist solely of residents of one race a single place of origin or one in
come level

Part of the Louisville plan includes an effort to encourage participa
tion on the part of residents in the community s government This is ac
complished by setting up relatively small elective districts (consisting of
200 families) In addition a series of monitoring boards are to be set up
to evaluate community services All service users will be asked to evalu
ate that service every two years As a result of these evaluations it will be
possible to depose administrators of a particular service that is poorly re
garded Overall a marked effort is made toward distributing power wide
ly and this is valued more than administrative efficiency Wherever possi
ble local control at the village level is set up over service agencies

It is still of course far too early to make any judgment about the sue
cess of the kinds of new communities envisioned m Columbia Maryland
or by the Louisville planning group Columbia is still in the building
stage The communities projected by the Louisville planning group are
not yet off the drawing board Clearly both enterprises are in some re-
spects more ambitious than the communes previously described and are
m other respects more modest As living situations that will accommo

ate literally thousands of people in entirely newly designed communities
t ley are ambitious On the other hand they do not pretend to alter the
social hung situation nearly as drastically as does the typical expenmen
tal community Only time and experience can demonstrate whether the
kinds of planning going into communities like Columbia Maryland will
enhance the quality of the lives of us residents and will prevent behavior
disorders r

CONCLUSION

Long before the general idea of community psychology was even conceived
con< y n « 1 ^out creating an .deal form of social organ.zat.on
mCCl " S ”11 S Pr,or to tlle 20lh century such social exper
n ems were generally impelled by values or ideals often cloaked in
religious terms that prompted a group of Idee thinking people to separate
themselves from established socte.y In the 20th centner some social ex
penmans have developed stm.larly but many are emergtng more as a
rejecon of the values of estabhshed soaety than as the afltata.ton of a
new set of standards

REFERENCES / 313

References

Eisenstadt, S N Israeli Society New York. Basic Books, 1967
Fairfield, R Communes USA a personal tour Baltimore, Md Penguin Books,
1971

Ranter, R M Communes Psychology Today,m0,4, S3

Ranter, R M Commitment and community communes and utopias lit
sociological perspective Cambridge, Mass Harvard University Press, 1972
Rinkade, R Commune A Walden Two Experiment Psychology Today, 1973, 6,
No 8, p 35 and No 9, p 71

Lemkau, P V The Planning Project for Columbia In M F Shore : l T

Mann.no, Mental health and the immunity problems, programs,

strategies New York Behavioral Publications, 1969 Pp 193 204
Nunn, D Netvcom, Volume I, Summary Louisville, Ky Urban Stu les en er.
University of Louisville, 1971 r

Sarason, S B The creation of settings and the future societies San Francisco
Jossey Bass, 1973

Skinner, B F Walden two New York MacMillan, 1948
Spiro, M E Kibbutz venture m utopia New York o en,

312 f the creation of growth-enhancing settings

to be extremely unstable. The modern commune seems to serve the needs
of particular individuals temporarily and acts as little more than a brief
way station in life.

Despite innumerable experiments with a variety of social organiza-
tions, one must conclude that we simply lack the social technology at this
point to design new social living situations that will be optimally growth
enhancing. It is probably also overly simplistic to expect that any single
model will serve all types of people. Perhaps the major problem encoun-
tered by the more successful, more long-lived utopian societies was ulti-
mately the fact that they could not adapt to changing external conditions
and the changing character of their own population. It may well be that
the practice appearing in Israel whereby the young kibbutznik leaves the
kibbutz where he grew up to join others in starting a new kibbutz is a
reasonable solution to the adaptation problem. It is, perhaps, unreason-
able to expect that the needs that drew the original settlers to a utopian,
communal living situation would be duplicated in new recruits who enter
the community from an environment that is different from the one to
which the original settlers of the community reacted. Furthermore, even
the children born in the experimental community are not likely to be im-
pelled by the same motives as their parents and caretakers. Thus many
models specifically designed to meet many different clusters of needs
may well be the only solution to developing truly growth-enhancing set-
tings.

One can be somewhat more optimistic about improving the quality of
life through planned communities. Clearly, it would seem that improve-
ments can be made on the haphazard social arrangements arising in a city
t at develops over a period of many, many years in response to a variety
of uncontrolled forces. To this point, there are too few planned commu-
nities and those that do exist are too few to permit any evaluation of how
they serve man. Clearly, they allow a more flexible living situation than is
true in many utopian social experiments, and by minimizing many of the

stresses of urban life while

maximizing the availability of services, they

should enhance the quality of life. They should also have a much better
chance of endimng than has been true of the utopian community,
lest Av ’ ° T™' cont * nue to dream, and certainly one of his nob-

he J I 'm V* ' Tea ' e a better worId in which to live. Hopefully

he* dreams mil be Rinded by the experience of dreamers of an earlier
me who attempted to build a reality modeled on their ideals. It is only
through such a process that we can hope to see the creation of truly
growth-enhancing living situations.

CRITICISMS OF CHANCING MENTAL HEALTH APPROACHES / 315

cism directed toward that mold m recent years Therefore, a central con
cern for the community psychologist must be the question of how broad
scale change can be brought to the mental health field What can be done
to shake up the old institutions and practices? As a first step toward an
swenng these questions, this chapter is devoted specifically to describing
and discussing the types of objections met m attempting to revise our on
entation toward mental health problems

The sources of opposition to change are pervasive Anyone who has
attempted to develop a community program in a traditional mental health
setting can easily attest to the omnipresence of dissent at local levels Dis
tressingly, however, opposition is also met even at the highest leve s o
the mental health establishment The Joint Commission on Mental Illness
and Health was established in 1955 by President Eisenhower with a man
date to study the mental health needs of the nation and to recomme ™
ways for meeting these needs This commission, supported by 36 national
organizations in the medical public health, mental heal ‘ h - we “ are ' e *“
cation, and social science fields included the leaders of Ammo* P £
chiatry, psychology, social work, education, and social sciences The
conclusions and recommendations of this august o y t ve men

series of excellent studies of theoretical issues t a con

tal health, methodological issues in ep.demiologiail research, ^eco-

nomics of mental illness mental health manpower p ,' churc j, e s in
resources in mental health the role played by schools

dealing with mental health P™ b,e ” s ' ^These conclusions, while ac
tient and outpatient care of the ment y „i V pment in the treat

knowledging the need for greater community l toward

ment of the mentally disturbed, quite speci ca , der The tone of
attempting to prevent the development of serious disorder T
these conclusions is conveyed well by this quotation

"Here, of course, we reveal the htas °fj^ T ‘ P °^ commitment to
discomfort to some of our colleagues w m0tl0n „/ positive mental

ward practices and programs aimed att * ^ ^ ^ c

health in children and adults ’ „„„ 0 i affirming this final re

mission have found themselves in p and 10 research, but

port as ,t relates to the treatment of the men, y beha „ o/ the

of re,ecung the view

mentally til would require ‘' ,e ™ ,n '™ im J e d, a te danger of becoming so
health of persons who are not , movement has diverted alien

We have assumed that the mental >6 ( u , s our purpose to

lion from the core problem “^“"oting the mental health o, the
redirect attention to the possibilities of. mp h

mentally ill " (Joint Commission. 1961. p

ii. criticisms of changing mental
health approaches

e preceding chapters have depicted the development of exciting new
manv nfTh m and “ Ie need to f °s'er mental health, as well as

of this rli le or ^ anize e K° rts to operationalize these ideas The purpose
nsvcholoirjl er IS l ° ? 1Ve . P ers P ectlTe on the extent to which community
a f00tl ; 0,d on the curren t mental health scene and,
, P „ , fnnL l P u fares ln ottempting to maintain this foothold

melv stia^l etr Pr ; SramS deSmbEd » this book have been rela

at deafu h 1 a ‘ med “ ‘ nCrcasln S ^ance on community forces
munuv orrel 7 man ‘ ' fat memal d ‘“urbance, and at changing com

cal disorder -n “ ' ray “7° prevem the development of pfychologi
d, re a uar. Jilarl mV °' VCd “ ‘ SO,a,ed “ hospital here or

an um JT7 ptogress.ve school system ,n one locale or another,

like Unm fon ' ard, ° okm S community mental health center, and the

mro, ', li y ' "? maJ ° my ° f mental h «>lth services available in
tins country still proceed in the traditional mold despite die heavy cnt.

314

OPPOSITION BASED ON THE ASSERTION THAT WE LACK SUFFICIENT KNOWLEDGE / 317

realms that would be necessary to succeed with such programs For ex
ample.

‘‘Even if we could agree on what kind of men and women we wanted
to produce , we could not predtct the outcome in a given family due to the
multiplicity of uncontrolled variables — such as the mathematics of inherit
ed characteristics Thus, primary prevention of mental illness has re
mained largely an article of scientific faith rather than an applicable sci
entific truth ' (Joint Commission on Mental Illness and Health , 1961, p
70)

This report goes on to point out that we are neither able to control or
even to agree on what would represent a proper psycbologica environ
ment for children and closes its discussion of the topic by asserting t
the results of establishing mental health education programs and child
guidance clinics have been disappointing with no convincing evidence
available that they have actually kept people out of state h ° s P
Halleck (1969) ts concerned that community psychiatry g
the practitioner into the political decision making arena for wh ch he has
poor qualifications and frequently little interest e P“
not possible for a mental health worker to enter the “mmumty arena
attempt to deal with the casualit.es of social conflict ^“hout attempl g
also t P o change the conditions that prod-<l the /rawnmm the

nonpartisanship or neutrality is not possi i j nca j issues Hal

community movement forces one ^er cannot differentiate be

leek is concerned that the mental healt having the force of au

tween positions taken as private citizens a Halleck feels mental

thonty as medical scientists As private ci i are , n

health workers both influence the eommun.ty climate -dm^
fluenced by it and have no special psyc hiatry (Dunham

Dunhams well known criticism that we do not yet possess the

1965) IS also based largely on the grout. ‘ commlinl ty psychology or psy
requisite knowledge to have an e « * , mp lications of a community
chiatry For Dunham one oft ee e ff e ct the patient and

approach is the idea that the j I[s structure Basic to tins

that techniques must be developed for altering

position is the notion that mnke ut> the

Within the texture of those msl, ‘"‘‘“"^""Zbcultures with unheal
community there exist dysfunctions \ lemlon s, various ideologies,

thy value complexes specific mslit pol ,„ ca l axes, occasional cul

conflicts along age, sex, ethnic, racial andjo^ ^ ^ ^
turn! crises, and an increasing tempo / jon(I , enm romncnt (Dun

tional interrelationships provide a pathog

ham, 1965, p 306)

316 / criticisms of changing mental health approaches

It is of considerable significance, despite the Joint Commission’s em
phasis on better treatment for those already disturbed, that much federal
legislation which followed the Joint Commission report was oriented to
ward the development of preventive programs (Caplan, 1964) Thus the
lay public seemed to acknowledge the need for prevention and were more
wiling to adopt a new orientation than were the contemporary leaders of
the mental health fields Along similar lines a task force on the mentally
handicapped established by President Nixon in 1970 to take another
overview of the mental health fields and to recommend necessary legislative
action, was unequivocal m its commitment to prevention and gave high
priority to the development of services for children, who were virtually
ignored m the Joint Commission report (The President’s Task Force on
the Mentally Handicapped 1970) Significantly, although the 1970 task
force included representatives of the major mental health fields as well as
education, many of its members were lay people affiliated with various
mental health organizations throughout the country

Given that opposition to a change in mental health orientation and
practices persists in a variety of significant quarters, it is important to ex
amine t e grounds on which these objections are based, and to attempt to
evaluate the adequacy of such grounds What follows is, therefore, a
roug i c nssification of various bases for opposing community and, partic
ularly, prc\entive approaches

ON THE assertion that we lack

PROGRAM^ KNOWLEDGr - TO ESTABLISH PREVENTIVE

nrc\rm^ Ctl ° n " C llC *“ sufI ' clcnt knowledge to attempt to create truly
Comm Pr0g T S " dl cxan P llfi «* by tire discussion of the Jo.nt
mo” mem VTV Tn' 7 and Hcal,h < 19GI > ™ the mental hygiene
the mental In' CGrS ' * le cnCT 8 e,IC figure responsible for initiating
I 1 , - : 7,' Cmen ,‘’ *“ -St-Hv concerned primarily Kith
131™, ,h r f Cldy mcm:,,1 y t" He ,s said to base been
interested in rttrmnr ' " S * ° Ct ° r friends oE t,los c days” who were more
ran «amnl« ofd " 8 ‘° mcn,al '''ness by following contempo-

mc^u coZnra, , “ ” E epidemic diseases As a resulb the more

C r W,5l,,nK c, " l<i K'ndance chnics and on programs
ttirbed ^ mr0rn,a " 0 " tor lra proring attitudes toward the mentally d.s

mmemem 1 ' T brMd a ' ms ot mental hygiene

7,7," ' "; c Jo,n ' Con ' m ' S! '°'< dismisses ihem as .machinable
Grounds for this rejection are the lad. of sufficient Lnowledgc in many

OPPOSITION BASED ON THE ASSERTION THAT WE LACK SUFFICIENT KNOWLEDGE / 319

arena where the prospects of success are better than they have been in
the more traditional ones

Dunham feels that some aspects of community psychiatry such as the
reduction of the psychoanalyst s and hospital psychiatrist s isolation may
maximize treatment potentials However he is extremely dubious con
cerning community psychiatry s future

" Here I am most skeptical concerning the adequacy of our
knowledge to develop significant techniques for treating social collectm
ties or for developing techniques on the community level that will really
result in a reduction of mental disturbances in the community It seems
that such expectations are likely to remove the psychiatrists still furt er
from the bona fide cases of mental illnesses that develop within the com
mumly context Much of his effort will be spent on dealing ™‘ h the J'° n
critical cases Until we have a more sound knowledge ^'t'ointo
dicate that the minor emotional disturbances are h ey °A four
the serious types of mental disturbances we mil be dtssipatl g
collective psychiatric efforts (Dunham 1965, p Ml)

The positions taken by the J omt 5*"“ onerareTy t'flver'rea^hes the
are in one sense very difficult to refut would like to have

point where he possesses all the knowle ge 1 ' a scicntl r ic field The situa
about the phenomena he is dealing with in worker in that area

tion in the human service field is no di =ren , ed fcy „ op ] e badly in
suffers an even more acute dilemma He i potentia I harm of a new
need of some form of help and m “ S ‘ ” a| g harm ^ not instituting such a
treatment approach against the po extraordinarily difficult to

program In many cases such weig | henoroena under consideration
arrive at because o£ the nature of P and ottlcrs however The
None of this refutes the arguments o vnmvledee to be comfortable

criticism that we are lacking in su programs is well taken

about proliferating all manner o c enthusiasm for the new ven

There is a real danger that came headlong into developing pro-

ture the community psychologist wi d o harm because necessary

grams that are doomed to fad or t a , es lt , ncu mbent on program

preliminary studies were not done T i , development to foster

organizers at this stage of community P > ^°& mns of ,heir programs
an investigative stance and to do ca researc |, devoted to under

Perhaps an even greater nee is m , community psychology pro-
standing the naturalistic settings m

grams will be set up strange awesome arena o

The community is indeed a my y o ung within the cio.stc
the mental health worker accustome P „ clear and Ins status

walls of the hospital or clinic where h.s

S18 / criticisms of changing mental health approaches

While Dunham acknowledges that the social milieu has long been recog-
nized as an important force in shaping personality structure, he is far less
certain that knowledge of this kind can be useful in work at the commu-
nity level that is designed to treat mental and emotional maladjustment.
He raises a number of questions for community psychiatrists or psycholo-
gists:

“Why do psychiatrists think that it is possible to treat the ' collectivity
when there still exists a marked uncertainty with respect to the treatment
and cure of the individual case ? What causes the psychiatrist to think that
if he advances certain techniques for treating the ‘ collectivity / they will
have community acceptance? If he begins to treat a group through dis-
cussions in order to develop personal insights, what assurance does he
have that the results will be psychologically beneficial to the persons?
Does the psychiatrist know how to organize a community along mentally
hygienic lines and if he does, what evidence does he have that such an or -
ganization will be an improvement over the existing organization?” (Dun-
ham, 1965, p. 306).

Dunham goes on to assert that the only proper community role for the
mental health worker is to assume public office as a private citizen rather
than as a professional. In that role he can attempt to use his professional
knowledge to bring about desired goals and, even if not successful, such
experience would be useful in acquainting him with the complexities in-
volved in dealing with the community as a patient.

As support for lus position that the mental health worker has little to
olTer in the community arena, Dunham cites two projects organized sev-
eral years ago to curb juvenile delinquency (one was the Cambridge-
SomcmHc study described in Chapter 9) and the overall impact of the
l” St ance movement as examples of previous community programs
um tailed for one reason or another. He also describes the progressively

in r'n " S dcflnilion of '''ness that has taken place over the past

or aO years, hut does not view this process as coming about because of
unmet social needs, the position taken in this book. Instead, he secs it oc-
„. causc * ,c mcm aJ health profession has been unsuccessful in
. '"L ° n ?' “ c Pj> cl > olics ’ and has, therefore, widened the “psychi-

10 <!< f people whose problems are more trivial and who
Icfm luTt ;°“ ,s,,n K treatment techniques. Tims the broadening
crumion of mental illness is a device cons, meed by the mental health
profession, as frustration, are met in dealing with "traditional mental
W „ ,lln f' 15 S "”P'>- redefined periodically to encompass prob-

nrosr K”'"" V ' ,C morc to current treatment op-

proaches. Movement toward community approaches is viewed by Dun-
1, am simply as another cITort of the mental health professions to find an

OPPOSITION BASED ON THE ASSERTION THAT WE LACK SUFFICIENT KNOWLEDGE / 321

breakdown of spontaneous social controls. This predisposses the immi-
grant’s offspring to adopt delinquent behavior if that is a significant
adaptive option. From this point of view, therefore, delinquency is a re-
versible accident of the person’s social experience.”

The second basts for the Chicago Area Project program derived from
two postulates related to sociological theory. The first states that a per-
son’s conduct is controlled by his natural social world. The rules of be-
havior that are valid for the individual are those that affect his daily
sustenance, his status in primary groups, and his self-development. The
second postulate holds that people truly support only those enterprises
where they themselves play a meaningful role. The implications of t ese
two postulates are that to prevent delinquency, a program must become
an integral activity of the adults who participate in the youngster s natu-
ral social world. The aims of the program must also become the ai
the local population which must take up the cause as its very own Fur-
thermore, those who live in high delinquency areas must become integral
parts o£ whatever constructive action is devised. d eveloD-

The program of the Chicago Area Project basically involved develop-

ing neighborhood welfare t^dghborhood's varied depending

quency. Specific programs in different g • j t an( j

on the character of the neighborhood, the type o however,

the facilities available in each neighborhood. For ^ r £ cre ltion pro-

all area project programs include three elements. (I) a recrea^
gram that, in some cases, included a summer c p . ' 3ms with police

paigns for improving the local de ( lin q uen ts, visiting those

and juvenile courts for supervising working with neighborhood

already committed to corrective rS to the commu-

gangs, and offering assistance to P s ;n , arge urban are as, proj-

nity. As in many modern commum > p h lice stations, and

ect programs were based in storefronts, churches, p
even the basements of homes. • d the identification and re-

• Establishment of these program* [3 tial positions in the neighbor-
cruitment of local residents who hdd J fl ' ™ ^ m operation. Over the

hood and who might contribute usefully ^ P f £ approved o£ the use of
abjection of professional socia! «or tha , employing individuals

untrained lay people, it soon ^“ advantages. The indigenous

indigenous to the neighborhood had y society , was able to commum-
worker was well acquainted with the 1 acceM to the commum-

To set up specific neighborhood pr g

320 / criticisms of changing mental health approaches

assured by tradition It might justifiably be asserted contrary to Dunham s
thesis that the mental health worker has resisted engagement in the com
munity for a good many years despite many forces impelling him m that
direction These forces include the moral treatment movement within the
mental hospital systems of this country during the 19th century Adolph
Meyer s attempt to develop an aftercare movement and to bring the men
tal hospital system out of its isolation and closer to the community and
the efforts of the mental hygiene movement to establish a truly preven
tive program The failure of the mental hygiene movement to diminish
mental illness rates through programs of public education as cited by the
Joint Commission may be attributed in part to the fact that the mental
health professions were not attracted to and did not engage in the pre
\entive aspects of the mental hygiene program They participated m the
operation of the child guidance clinics set up by the movement but m
these settings they maintained a traditional role
Dunhams citations of failure of previous preventive efforts also de
sene scrutiny Two of his examples the Cambridge Somerville Youth
Study (Powers and Witmer 1951) and the seeming failure of child guid
incc clinics to dimmish the adult incidence rates of major psychoses
while preventive in aim involved traditional approaches to dealing di
rectly with behavioral problems In the Cambridge Somerville Youth
uc y tie wor ers were specifically prohibited from attempting to manip*
u h te the delinquents environment The study was a test of the benefits
, env f from the relationship between counselor and counselee
ic child guidance clinic while problems are addressed early in the life
neutir T 7 C Ua l ^, ey are a S' un d ea lt with in a traditional psychothera
tcmms it nr ° ne ^ atlons ^ , P Thus while these examples represent at

communuv nr enlI ° n u ey are not attem P ts in the spirit of the types of
community programs that are currently evolving

\oUes the r ch"? Pl I ° f a P revious Preventive effort cited by Dunham in
lte d ll r r f Arca <**"" 1959) initiated in 1930 to re

Tins t r r c uLn° nS e 1 r er Ch5S groups of Chicago

K no™ ' 71 1 S0C,0 ’°S ls ' Alford R Shaw a! described by

com^n nro,et C d " d<nl "* ««h many types of

or i p jjo des,sn v sed on r

Imqucnr, can lie understood „ , assumption that most de

soung boys arc not able to find me pr °f css of socnI Ie '> rnl nS ttherc
Itonance for them parents and base comaa *' h "" ,,t,,,,ons ,hat ln . vc ,m
■> 1 till tradition of delinquency Trom ,1 P” r S rou P manifesting

i* a wa\ of ^ , , om 1 ,,s Mew Incoming a delinquent

prmluct of a , ™ 1 '«pectcd adult rol e rather than simply being a

grant from a tv ‘ m,n & T 10 socnl change confronting die immi
gran, from a peasant or rural society to a large urban area leads to a

OBJECTIONS BASED ON WHAT APPEARS TO BE THE SHEER ENORMITY OF THE NEED- / 323

ventive programs and carefully studying them Perhaps the difference be
tween this view and that of Dunham is related to what are regarded as
the forces impelling current community movements Dunham asserts that
psychiatry is moving into the community because it has failed in its tradi
tional functions and is embarked on a trip hopefully, to bolster the ego
of a group of frustrated professionals This seems to be a gross oversim
plification It greatly overestimates the degree of personal dissatisfaction
experienced by the majority of mental health professionals concerning
the invalidity of their techniques Furthermore, it greatly underestimates
the potential for denial among such professionals most of whom are no
engaging in community enterprises, are very content wit ra l *
practices, are unmoved by research findings and are -latjve y uncon
cerned about major metal needs Dunham’s view a so pertly u " deres ‘'
mates the threat posed for any traditionally trained professional * ™
prospect of leaving traditional positions, where high statu and good n
come are assured, m favor of entering a community arena fraugh with
all of the uncertainties that Dunham describes From our P““ ‘

the impetus for current communtty movements can
stemming from the urgent need for m cholera or typhoid epi

of behavioral and social problems T ese, , ct , 0 n be taken based

demies that once sweep a community demand that action
on even fragmentary knowledge

OBJECTIONS BASED ON ' lUGH COST

ENORMITY OF THE NEED AND ITS HU

Some who acknowledge the desirability ° f ^'“‘'J'tab’hshment on the
tal health problems nonetheless °PP or socia l change which

grounds that truly effective program t j 1JS viewpoint, preventing

is virtually impossible to bring a 01 f a u injustices discrimination
emotional disorders requires the abolition of ^ I969) Those

economic insecurity, poverty, slums, and be J,ke attempting

who take this position ‘ hat ‘°v t ■ Efforts short of such fomndab e
‘ to fell a giant sequoia with a to F d therefore, the most

social changes are bound to be s*^^*,** such as the d.agnosi
can be don! is to concentrate » manifesting menial d.sor

treatment, and rehabilitation of those

de An argument against the es.abbshmen. of prevenme apP-- ^

is associated with the issue of the eno ams are> indeed

cost (Cowen ' J967) Most P rc ' e "‘” e F r They require highpneed pro-

particularly in their developmental stag

322 / criticisms of changing mental health approaches

founders learned that they had to study local social organizations, be-
come acquainted with the history of local institutions, and learn about the
local power structure with its various conflicts and cleavages to be effec-
tive. The well-structured, stable neighborhoods were dominated by one
or a few local institutions. In such circumstances efforts were made sim-
ply to operate through these established institutions. More often, neigh-
borhoods were not well structured, making it necessary to operate
through a variety of local neighborhood institutions such as churches, po-
litical organizations, businessmen’s groups, or lodges. In many respects,
ranging from the underlying theoretical orientation to the programs that
have included the use of indigenous workers, the Chicago Area Project
has a surprisingly modern ring and stands as an important pioneer of the
community movement in urban areas.

Dunham s dismissal of the Chicago Area Project as an example to
“point to some of the difficulties that are inherent in any proposal that
emphasizes the development of psychiatric treatment techniques for the
co ective evel is based on the fact that, in attempting to evaluate the ef-
fects of the Chicago Area Project, Kobrin (1959) emphasized the prob-
em of deriving precise measures of program effects. These methodological
problems result from the reality that large community areas are sub-
ject to a variety of forces that cannot be experimentally controlled. It is,
v e rf°^’ dl ? CU t t0 sort . out Program effects from the effects of a varie-
y o other forces operating on an area’s residents. Thus, Kobrin cau-

a Simp,< L reduCtion in ^inquency rates would not necessarily
mdicate program effectiveness. On the other hand, Kobrin asserted that

T? c i a - yti ' S rounds '’ lhe Chicago Area Project was a *uc-

vomh i a . Chievements ^luded: (1) the demonstration that a viable
auenrv orr. arC °^ an * zation could be established among residents of delin-
S (2) tha ; mdigenous workers could make personal contact
h, U T aChaWe b ° y5: and < 3 > !t 5ucce eded iV rendering less
ntHlte ddinn, " rba " s ? c,et fs k S*! machine for controlling and reform-
Cffcct o fl e Ch" Q T ney <1970) Concurs w!tl > evaluation of die
o h ° a , Pr ° im hh -cent book on crime. Al-

ones thev are no,™? pr ° b, ' ms !nl,crcnt i" evaluation are difficult

matched to program arcMa^mrok and T'f' “* ° f nei S hborho<xls
mism. Admittedly, the stated accomul ■ T* '° warrant Durham’s pessi-

Rram coal (WinmiPnr, a ' • Pediments are not the ultimate pro-
^s^lt ? "T '»■' um. instead, the means to such a

Wh'rc ’ " 0l 5m,am D,mbam ' s *!■» that the program was a

^ whiIc mental health professions
!iiw?,? e?i?3. .t , Sa ," R '"" tbc ' r S a P s in knowledge concerning

og>, tins lack need not block all efforts at establishing pre-

OBJECTIONS THAT PREVENTIVE PROCRAMS INVADE PERSONAL PRIVACY / 325

some by the potters that be Halleck points to the practice in the Soviet
Union of pronouncing insane many who are regarded as dangerous to the
state as an example of the type of abuse of mental health practices by
which society is threatened Another example he offers which strikes
closer to home is the poll conducted by a national magazine during a re
cent presidential campaign asking 13 000 psychiatrists to ju ge t le psy
chological fitness of one of the major candidates, whom none had ever
examined A more recent example that may be even more lsquietmg
those with Halleck’s concerns is Clarks (1971) advocacy of the adm ms
tration of behavior controlling drugs to society s power controlling

,e This type of objection to preventive programs and in fact, to virtually
any efforts that are advanced to reflate socmty in orde to d tea! wdha

major problem, such as polio '"“f^emlld Se frontier American
ly rooted in the individualism that e . me dt

Admittedly, some societies have = mental health ^

cine in general as a means of contro S , control over the

this has occurred in societies with long tra 1 d h gfl t j, e mental
individual If such control had "" “extend !„ some olher
health professions it would P r ° ba ^ d b a reslst ance to controls
way The American trad, ion . ‘character ^ fQr , he society

including many that would seem j legislation and control

as a whole The difficulty of passing g current examples of this phe
ling concentrations of lead in t e am re[0grmed that our survival

nomenon Despite such resistance, it -has ■<> ^ klnds ot controls

and existence as a healthy society freedom s and a certain amount of
that necessarily require giving up some automobiles school at

privacy These include regulations on he me

tendance and physical hygiene and san.tat.o ^ ^ ^ (he potential
The fact that Americans give gru gi ' a slre ngth that prevents

loss of personal freedoms or privacy P Nonetheless some indmd
the abuses of control found in other ^ ^ wlll r e S ult in the persist
uality must be sacrificed when fa, ‘ ur ' 1 llC w point the notion of a

ence of social problems Thus e „ ere nnot for the fact dial be

community psychology would be impossible ^ ^ __ a[ grass roots
cause of a variety of social pro ’ con cerned about the po
level By contrast, those who are by comro „n.ty

abridgement of personal lreedo P ume that the impetus fo
such as Dunham and Halleck teem » £ , tllcr a state ».<>.<

r^rnCTams derives from a OTofe5S , on like psjclin

oping community programs^.**’ ©ntrol, Qr m a

ulterior motive of intensi yi 0 e nt

If this were

ulterior motive of intensi yi 0 ent to bolster its eg t j 13 t

try that needs the community founder m a society

truly the case, the movement vv

324 / criticisms of changing mental health approaches

fessional personnel over long periods of time. Often the public is asked to
support programs that are entirely exploratory in nature, have few if any
precedents, and are without promise of an immediate payoff. The neces-
sity of making expensive investments toward an often intangible outcome
that may require years to assess tempers the enthusiasm of many people
for preventive programs.

Admittedly, establishment of the ideal society which would minimize
the development of emotional disorder is a remote ideal. On the other
hand, our immediate needs are such that as Bower (1969, p. 6) puts it,
“small beginnings, however, need to be made on many fronts.” The prob-
lems encountered in managing those already identifiably disturbed emo-
tionally is becoming so overwhelming for the mental health field that it is
imperative that even small efforts be mounted to reduce the numbers suc-
cumbing to mental disorder.

The issue of the high cost of prevention programs is placed in perspec-
tive by Cowen (1967) . He points out that costs currently entailed in
managing many emotional disorders, which society is accustomed to
rearing, are enormously high. Processing a single adolescent through the
New York City juvenile court system costs $4000. The average costs to
an urban community of an adolescent who drops out of high school and
later enters the welfare roles is approximately $30,000. Residential treat-
oTon? ^ f ° r th ° Se sufferin S emotional disorders can cost in excess of
$15,000 per year. Custodial, state hospital care for a long-term mental
patient may cost as much as a quarter of a million dollars. Thus even the
inadequate mental care system being supported today is an extraordinari-
y expensne one. From this perspective, investments in preventive pro-
' ■ 1 P rovi de the hope of diminishing the long-range costs of
i^dal cost'' nESS Kem eminentIy ' vo «hwhile despite their obviously high

rKm S tv,Mn D ° N THE roEA THAT preventive

PROGRAMS INVADE PERSONAL PRIVACY

Krauts iiTthe ^ te " | d . * >y |* le P oss 'bi!ily that community preventive pro-
Z Torn ITT hea, . th r,eld will invade their personal privacy (Bow-
nrivilKe 'to mind , C - S0C ' et l Cadl individual it » his right and

Hailed ft. | 1S us ‘ ncss an d to expect others to mind theirs,

of "medical f ■ S ' at ‘ he , danser in comm »nity psychiatry of the use

H “ “ tI ,’° SC With de ™"l Political or ethical be-
n Vnrm , , rCC ° gn ' ZCS ,hat "'o growth of community psychiatry
I . h co CXpa , nS, ,° n ° f ,hC '““P 1 ° f mental illness, and fears

that it could come to include whatever behaviors are regarded as trouble-

PREVENTION AS NONPALPABLE, FUTURE ORIENTED AND OF UNFROZEN QUALITY / 327

the romantic ideal persists, and frontier psychology characterizes the atti
tudes of many in our society Some of the effects of its value system m
elude "highly competitive territoriality, whose restrictive covenants, se
cret collusions, need for scapegoats and consequent discrimination are
witnessed in the disadvantaged states of women and of certain races and
minority groups” (Rome, 1969 p 39)

The attitudes that simplistically regard men as winners and losers are
being challenged increasingly Bower (1969), for example, points to
mounting clinical and research evidence indicating that successful adults
were successful as youngsters, and that those whose adult ie is e
with frustration and failure tend to have had similarly unfulfillmg chil
hoods This shakes faith in the basic assumption of frontier psychology
that everyone begins with the same chance Likewise, as ome in
the social problems provoked by an exploding population demand « ha
conflicts be dealt with before they erupt into senous
prompts a more realistic, careful look into then | ““^^" Vlduahstic bar

r because of - = „ob-
lems that will inevitably persist unless viewpoints and approaches g

OBJECTIONS BECAUSE N I ^^uNPROTCN N QuIu I ?Y I!I ' r '’
FUTURE ORIENTED, AND OF UNFKUvr.1 vc

, , ,hu among the difficulties in arousing

Cowen (1967) has pointed out that ^ 00 ^ ^ u [he fact that

public and professional interest in P r lin d raising programs for sup-
they are nonpalpable and future oriented suffer

porting preventive approaches m ■ Campaigns to support re-

ing with which potential donors dystrophy lean heavily on

search on polio cerebral palsy, or ^ „ ,n bmee, on crutches or in
posters displaying young attractive c readily identify "ith such

wheelchairs While most potentia on t { ieir own family or

physical disorders, or see them a ,ct,n ^ 2r0 used over the possibility of
friends, they are less likely to be simihi J IC ^ ster d.splay can char
being stricken by mental ,Uncs * d, SO rder in such a way as to m uce
acterize the neurotic or person y m0 st dramatic exampl

strong support for preventive measure wOU j d be the severe p*>

immediate suffering caused by men j, as extreme difficulty accept

chotic Generally, however, the lD „ thc plight of sud. .inform

ing the possibility tliat they arc vu n | !or( Icr lias been a difficu t one
nates Thm the need to present menu l disordw ^ ^ ^ for 5Uch ef
impress on the general public, par i
forts tends to be in the distant utur

326 / criticisms of changing mental health approaches

jealously guards its traditional freedoms. Furthermore, community pro-
grams generally require the active participation of the citizenry if they are
to survive. Thus they are more subject to community wishes and needs
than are traditional efforts which often are carried out with only passive
community assent or even legalistic force as backing.

OBJECTIONS BASED ON A SOCIAL NEED FOR WINNERS
AND LOSERS

There are some who would interpret our society’s resistance to the solu-
tion of many social problems as being rooted in the simplistic traditional
view t at people are either "good guys” and winners, or "bad guys” and
losers (Bower, 1969; Eissler, 1955; Rome, 1969) . According to this
view, m a free, individualistic society each person begins with an equal
opportunity and by conscientiousness, hard work, and good intentions he
can be successful. He fails if he has not been conscientious enough, has
been lazy, or has been badly intentioned. This is the theme of the popular
iorvnir^v a u 15 ‘i* eSSenCeof the co P s “d robbers drama. A ma-
for himself It 1S V, C - me ° r society ‘ s t£lat through overt success one proves
or if OS 15 0ne the g0od SW' 5 - » the re were few or no losers,

advantaoe^in a *l reco ^ nize<£ o£ten _ as being caused by starting out at a dis-
would Ik tarnished Same ’ ‘ * satisfaction o£ winning or being successful

wlfether'sor 9 ! 5 - *" uZ™ 5 ° E delinq "™< :y in this country, questions
h pies ze It P m COmr ° lli,lg ddin ^ency is mere accident. She
of such a at . S0C ' ety may llave a need for its criminals. In the service
h vio r and elTm' T T’ ^ individuak are seduced into criminal be-
Rome (19691 l, y ” “ prCTem SUd> ““»««■ is resisted,
individual in inn °“i cultural values us setting the needs of the

an.r 8 o„ism"„ soch! 1050 ° f sodety ’ these values, there is

that all men must' WTreaTed aTTflT" 1 °' pa,cr " alism ’ and insistence
not impeded by society man is ? equal - Furthermore, when

and wants provided that h. i P cs 1 t ™ cd ca P a ble of fulfilling his needs
facie cvidenlulVe l;:al PP ^;it" 1E ^ *?* b ^

failure qualifies him for being taken ram oVl" ! ° m - e ,m P orlant ™ y - Such

a level equal to what he coidd have child , tby "°

Rome, terming this individualistic set of vahfes ufmnT S °'Z

heves that the attitudes which glorify this r^'i

more ohm T'iick'^.^clrf ST“h" 7* ° f ‘ Cn ’ h ™8W^=™ “"d stfH
—nlyhiswife,^^

OBJECTIONS ROOTED IN THEORETICAL VIEWS / 329

ignoring or denying a tremendous amount of evidence that would (a)
question the general utility of intensive psychotherapy and (b) regard
traditional intensive psychotherapy as particularly inappropriate for the
lower classes (Bernstein 1964 Bredemeier 1964 Reiff 1966) Mental
health professionals working with the lower classes have long recognized
that the poorly educated and impoverished view their problems as imme
diate ones requiring solutions that are as tangible and prompt as possi
ble The poorly educated economically deprived patient has been noto-
riously impatient with and unresponsive to psychotherapeutic approaches
stressing the need for insight into deep psychic needs As a result as Bre
demeier (1964) has pointed out the mental health professional has re
acted by labeling such individuals as being inferior and umvorth> of his
attention Training more intensive individual psychotherapists wou not
alter this state of affairs Furthermore Albees research (1959 19 )
would indicate that we cannot possibly tram ind.v.dua therapist i m the
numbers required even if the service they could provnle were altogether
effective The answer to the problems of the poor inev. tab te ■" ap-
proaches that are different from those that hate been trad, .tonally P™
need

OBJECTIONS ROOTED IN THE TTDTMUTrCAI. MEWS
THE CAUSES OF BEHAVIOR DISORDER

Traditionally the behavioral sciences ! ' aVe in

for behavior in general and behavior isor o[ p,, rs0 nalit) ihco-

ternal to the individual The earliest approx of w Inch focused

nes were churacterologies (MacKinnon i crsona i, t y character

on physiological makeup In ancien mtcrnal combinations ol

istics were thought to be expression r m 0 scnlnn and London

four basic elements — earth air ire an afferent Icm peramcntal types
1968) Different combinations resu tec i >e ln\ior a person would man
and these in turn determined the me t j, c ^cars has prompted

ifest Although a developing sophistica thcrc have been con

the rejection of ancient theories of temp mt|CS UIt h temperamen

tmuing attempts to associate persona i e 0 f the individual Ti

al attributes rooted in the ph>sio ogx certain character t>pes parucu
the end of the 19th century the ulea ‘ p I, Biological smir

larly the socially deviant ,, ere rooted in an ^ and KralTl Fbine
tnre w as popularized in the . ghcldon conducted lm;!i v

Uaier typo^is.s such «•**» ** ' 1 *~ ' mr ~

plusticated research on the r
ment and behavior

328 / criticisms of changing mental health approaches

Associated with the nonpalpability and future orientation of the pre
\entive program is the further concern that prevention programs have
not yet proved their worth Lack of tangible evidence of the effectiveness
of prevention programs was one of the reasons cited by the Joint Com
mission on Mental Illness and Health (1961) for their own emphasis on
dealing with manifest mental disorder Of course the long term nature of
preventive programs and the fact that their effects cannot be assessed for
some time makes it difficult to provide tangible evidence of success Fur
thermore these programs are often instituted in complex social situations
involving a variety of forces many of which cannot be experimentally
controlled Thus the methodological problems in providing good evalua
tions are in truth complex as was pointed out by Kobrin (1959) in
connection with the Chicago Area Project
The objections to preventive programs cited here have no doubt
impeded their development for many years If traditional mental health
approaches seemed at all adequate it is highly likely that these objections
would continue to prevent the establishment of preventive programs The
increasing demand for preventive approaches to a variety of problems
speaks to the failure of traditional approaches If already manifest prob
lems could be treated successfully and quickly prevention would have lit
tie or no appeal Therefore the willingness to delay gratification and in
vest in programs that cannot demonstrate their utility in the immediate
future his become an absolute necessity

OBJECTIONS BASED ON THE IDEA THAT PREVENTION
WOULD RESULT IN POORER TREATMENT FOR THE
IMPOVERISHED

Hillock (1969) points out that although one of the more exciting aspects
of community psychiatry is that it holds out hope for providing better
care for the impoverished it may paradoxically merely intensify current
inequalities in our service delnery systems While he recognizes that
community approaches would bring many new services to the lower
c asses Halleck regards .t as unlikely that these new approaches will in
elude intensive psychotherapy Instead considerable environmental ma
mpulationwi be imohed and drug therapies brief psychotherapy and
counseling will be stressed Thus he suggests that a wiser approach might
be to tram more individual group or family therapists who could prac
ticc intensive psychotherapy

Tins ope of objection is Inset! entirely on a mine system tint places
■min, dual psychotherapy at the top of a hierarchy of treatment for men
tal problems One can only continue to maintain such a value system by

DISSENT BASED ON THE THREAT TO THE PROFESSIONALS ROLE / 351

than Ins remote past Operating on the basis of such a viewpoint and
through using certain laboratory derived principles of learning \ery 1 m
pressne behauoral changes ha\e been demonstrated in individuals m a
variety of settings including hospitals and schools

Kahn (1968) has applied the implications of organizational research
to mental health problems and concludes that to be effective therapy
must be less compartmentalized less separated from other agencies of
socialization For him the classical therapist patient model with its iso
lation from the social context is ludicrous His point is well made by an
analogy he draws involving a boxer and his adviser

•The patient and therapist laboring in these circumstances are remims
cent of a prizefighter and his second caught in a nightmare situation
fighter is taking a terrible beating under circumstances that the second is
forbidden to witness , from adversaries that the second is forbidden to
meet, and whose onslaughts he can do nothing to proven eve ,

the fighter returns to the second for a few minutes after
repairs and advice that he is allowed to get from ™ other source J° h ‘
student of human organizations, ,t ,s a terrible and marvelous concep
tton" (Kahn, 1968, pp 70 and 71)

Thus a growing trend within

soaal and environmental forces n dc ^ pro fc SS ionals think al

very significant numbers of tradition * , forces as being the most stg
most reflexively of deep lying P 5 ^ % t0 operate on that basts In

nificant factors in behavior and will mvchiatry Halleck (1969)

his above mentioned critique of c °”T siring the importance of internal
reveals the traditional bias toward e p • 6^ undoubtedly receive in

psychic forces by pointing out that P hjatry because they mil

fenor mental health care through commum J ^ ,Y our resources were
receive less intensive psychotherapy “ , m „i, C it bias among tradiuona!
invested in training more therapists search for deep-lying inter

ly trained mental health workers a ' 01 ™ development of community
nal sources of behavior doubtless will imp
psychology

DISSENT BASED ON THE THREAT TO

PROFESSIONAL'S ROLE psychology resides

Perhaps the most formidable reS ‘ S ‘““ ^professional rote are threat

n mental health professionals w o exemplifies this point qui

med by the new movements Hallech Upbeat, on of commumt) ps)dn
ixphcttly when he asserts that a ma] P

330 / criticisms of changing mental health approaches

Although many other psychological theorists rejected the idea of a di-
rect relationship between constitutional makeup, heredity, and tempera-
ment, they did not reject the idea that the essential forces that determine
the way the individual behaves are internal. Although Freud, for exam-
ple, attributed great importance to a person’s experience as a determinant
of his behavior, thereby minimizing the significance of constitutional
makeup, he regarded all behavior disorder as deriving from patterns that
became fixed in the first five years of life and continued to exercise their
influence throughout the remainder of one’s life. Many other personality
theories have differed in content from Freud’s but have held to the basic
idea that the earliest learning experiences set up predispositions that are
carried throughout life and that play an inordinately important role in de-
termining behavior. Traditionally, most psychotherapeutic approaches
have involved attempts to derive greater understanding of the internal
forces that propel the individual. Many brief psychotherapeutic ap-
proaches have continued to be influenced by psychoanalysis so that, while
they probe less deeply, they nonetheless emphasize the past and its role in
determining present behavior. Even in recent years, the development of
the encounter group has involved an attempt to acquire deep understand-
ing of one’s own internal processes, presumably as a way of better under-
standing and regulating behavior (Zax and Cowen, 1972) . Likewise, re-
cent y popular cathartic therapies (Janov, 1970) retain an emphasis on
internal factors.

The emphasis on the role o£ external forces in determining human be-
havior has been a traditional focus of sociology, not psychology. In recent
y ?f rs ’ ° wever ’ psychologists have become more and more concerned
about the impact of external, often social, forces on the behavior of indi-
V! uals. Hunt (1968) , for example, has discussed competence— skill in
symbolmng, in being able to solve problems, in being future oriented,
fmrnm m ° tiv ^ ted to achieve and assume responsibility — as deriving
v :j, 1 a „ S continum g interchange with the environment and other indi-
a tenL mUS T COnsiderable evidence to support the notion

ors h L”?" as a characteristic fixed by internal fac-

multituS of V , y , “Pccicnce. This evidence is drawn from a

km oTvtne lb ,T'% ln Udmg «“*“ *“*= theory, studies of the prob-
of human infan I 7 ’ StUdieS ° f the Philological development

l ee Zts cross-cultural studies using so-called “cultural-

h a an . a PPcoach which is achieving greater and
these days is another movement that placef great em-
£ vi “ n ’, C 1 . efFCC,S of ““Cdtate experience in shaping and maintaining

nediam e ( "7 ‘ %9) ' From thi * viewpoint, man’s im-

nediate experience is far more significant in determining his behavior

DISSENT BASED ON THE THREAT TO THE PROFESSIONAL’S ROLE / 333

selor and guidance worker must cope recognize them as extraordinarily
complex problems, equally as demanding of psychological skill as the
usual clinic functions. The reason most mental health workers have failed
to recognize this is because they are ignorant of the problems dealt with
in settings other than traditional clinics and hospitals. As a result, estab-
lished mental health professionals contribute little to the training or prac-
tice of many individuals attempting to cope with very serious and com-
plex psychological problems.

Bredemeier (1964) has done a provocative market analysis of t _ e re-
lationship between the socially handicapped and tra itiona menta ea
agencies. Among the “costs” to agencies of accepting patients om
van, aged backgrounds, he lists the potential obsolescence of the method
used by traditional personnel. Bredemeier points out that ll>
skills and ideologies of typical agency people have been devdoped To deal
with a client who is different from the one coming on, o f a d, advantaged
background. Considerable reliance has been P ,a “ the motivation to
of a home and community that has s built into > « ! c 1 ^ wha(

use the services and techniques offered y S ^ we] , , vith those
pretty well with the middle class dien . t j, at t j, e y have

from the lower dasses. Middle class patien^ ^ inv0 , ved enough t0

problems, are motivated to ask for p. Iiro f es sionaI to another
weather the routine of being referred om 1 j e problems

before being offered help. Lower dass bents fad J ^ be

in many cases, are afraid to approac S ^eing shunted from one

too confused or too poorly motivated to accept g

professional to another. attempting to change

What is the price agency personnel m P ^ ^ the needs and char .
their techniques and approaches » « identif ; e5 thre e types of costs,
acteristics of the lower classes? JJ Q f se lf-respect. To some

The first has to do with the pro essiona ^ o £ t h e c jj ent that he serves,
extent, professional status is tied to t e q £ t jj e professional, and to

The lower class client adds little to tes^ fe . )ure o£ his tra ditional aj>
treat him, the professional must classes as being somehow

proaches. Thus it is simpler to reject the

inherently inferior. As Bredemeier s a - hi, tech-

“ It is as if our hypothetical P^'^^Leons, hastened to assure
niques for reinforcing rats did not vi nolorious f y inferior creatures any-
himself and bystanders that pigeons a unfortunate assoc, a-

may, and he is not to be ju d pdan‘”

lion with them" (Bredemeier, ,■ attemp ting to treat

A second price that the P™"‘ Squiring his clinical skill.

the lower classes relates to

332 / criticisms of changing mental health approaches

try is that it thrusts the psychiatrist into a number o£ administrative roles.
He questions whether those roles are suitable for the physician with typi-
cal residency training and fears that the public will be the loser if the psy-
chiatrist spends more of his time in “administration" and less in direct
clinical practice where his primary training and expertise lie. Other ob-
servers, concerned about the same issue that Halleck discusses, take an
entirely different view. They regard the tight specialization that Halleck
believes serves the public best as a weakness. Rome (1969) , for exam-
ple, describes technological advances within medicine, which have inevit-
ably been accompanied by greater and greater specialization, as a process
that has fragmented interests and has led to a damaging compartmental-
ization of services. Emergence of separate structures has led to factional
differences that have diverted professionals from pursuing their proper
goals of high standards of practice and knowledge toward defending the
social or business interests of their own particular specialty.

A somewhat similar concern over specialization dangers is expressed
by Sarason, Levine, Goldenberg, Cherlin, and Bennett (1966) . These
authors speak of a “professional preciousness” which is one of the detri-
mental consequences of the parochialism of the mental health profes-
sions. This term refers to “the tendency to view what they are and do as
unique, and to believe that they are the only ones who 'truly’ understand,
grapple with, and effect changes in individuals beset with problems in liv-
mg and adjustment" (Sarason et al., 1966, p. 34) . As an example, they
i e ie ear y years of the child guidance movement when the functions

thC I ari ° US members o£ lhe dinic team were rigidly differ-
h 1 ' . e psychiatric social worker was restricted to doing casework,

teL PSy t° S1St dld P sychol °g icaI ‘“ting, and the psychiatrist was the
m member responsrhle for treatment. Gradually these interprofessional

nraafceTh^ v d ° Wn and ’ in most clinics. psychotherapy is now
ra^suffereH n n ° npsy atriStS ^ "° SU S««‘ io " that treatment quality
stead of a ™ eC h USe ■“ ” ' p “ fa ™ ,ed by a "onmedically trained person in-
e o,vAo,herf‘ nSL , HO , WeVer ’ ° nce psychology and social s7ork won
otLr Sun, ,h P I <hey ' t0 °' ad °P ted a "Precious” attitude toward

worker “he vot , “‘f ta tWs ” hol y" »>=- Thus the guidance

^f d y 0 :^

L complexhv ’f d ST"* P ™ aiK ° f Passionals and
I hZ S, F r0hl , ems . wi,h "-hich they attempt to deal. Those

ose y at the situations with which the vocational coun-

REFERENCES / 535

Bernstein, B Socnl class, speech sjstems, and psjchotherap) In F Riessman J
Cohen, £. A Pearl (Eds ) , The menial health of the poor New York Free
Press, 1964 Pp 191-204

Bower, E. M Early identification of emotionally handicapped children, 2nd ed
Springfield, 111 Charles C. Thomas, 1969
Brcdemeier, H C Tlie socially handicapped and Ihe agencies a market analysis
In F Riessman, J Cohen, t A Pearl (Eds) , The mental health of the poor
New York Free Press 1961 Pp 8S— 1 09
Caplan, G Principles of prn entire psychiatry New York Basic Books, 19H
Clark, X B The pathos of power a psychological perspective American
Psychologist, 1971 .26, 1047-1057

Cowen, E. L Emergent approaches to menial health problems an °' e " ,e " ' “
directions for fan. re work In E. L Cowen E A Gardner, X M Zax (B&) .
Emergent approaches to mental health problems New York Appleton Ce
tun Crofts. 1967 Pp 389-455

Dunham, H W Community psychiatry-the _ newest erapeu 1C

Archives of General Psychiatry. ScarchUght s on

In , M

n^Roberts,^

City, N Y Doubleday, Anchor Books, 9 P w Carter Jr

Hunt, J McV Toward the prevention of commumty mental health

(Ed ) , Research contributions from psy ' ®j w5
New York Behavaoral Publications, P ns 1970

— • V/irt G P Putnams sons,

Janov.A The pnmal scream New tort. Action for Mental Health New

Joint Commission on Mental Illness an ea

York Science Editions 1961 research for community mental

Kahn. R L Implications of °^"'^"rch contributions from psychology to

health In J IV Carter, Jr (Ed).K Belrmo isil Publications, 1968 Pp
community mental health New York Bella

60-74 „ v ,„ assessment The Annals of the

Xobnn, S The Chicago area Saences, 1959 322, 19-29

American Academy o, Political InJ Mcv Hun. (Ed).
MacKinnon, D W The structure o Ronald. >944 P P

Personality and the behavior disorders, lol

prevention of delinquency New

Powers E.SL Winner, H E*P ert ™ '

Columbia University Press, 19s Llt tle. Brown %. Co 39/

Qumney, R The social reality of crime mstitutional change men

Reiff R Mental health manpower

ts? £>.

health centers 1“ L 1

334 / criticisms of changing mental health approaches

Considerable time and effort goes into the training that provides the tra-
ditional skills for dealing with psychological problems. To set these aside
an attempt to acquire a new set of skills means writing off a consider-
able investment. Worse yet, to some degree, most professionals have begun
to identify with their old methods. Writing off a hard-won well-practiced
model of functioning is like giving up part of oneself. The resist-
ance to doing so on the part of agency personnel is likely to be as ten-
acious as the resistance of the handicapped client to giving up the self-de-
feating behavior which is felt as part of himself.

The third factor that prompts opposition to moving toward new ap-
proaches is the fact that success is not assured by new methods. The ab-
sence of such certainty, in a realm where success is highly important,
leads to the endowment of a magical quality to whatever methods are
used. Thus the method becomes a "reassuring ritual" which is difficult to
relinquish unless it can be exchanged for some other form of reassurance.

The resistance of professionals themselves, who must help bring about
the changes leading to community psychology, is quite formidable. In
many instances, professionals block initiation of community approaches,
-.qua y amaging, they often operate in subtle ways to undermine al-
rea y established programs. Considering the potential power o£ this form
0 rcsist ance, the ever-growing numbers of community psychology pro-
grams that are emerging testify to the force of the social need impelling

CONCLUSION

This chapter attempts to summarize the types of objections to establish-
fnlH L; t0I11T1 '' ,lni ,' V P s 5' choI °gy- The sources of this opposition are mani-
cietv lu " 6 resl . e ln the attitudes and values characterizing American so-
take the 1 1 1* - ”1 316 £ound wlthin the professional groups expected to
H : the community movement. The array of Jritichms is so
Jhas min u many 7“ marvel at the £act tha ‘ community psycholo-
fnlv be n "le 8 f t “ h eVe " the £ °° lh ° ld * now enjoys This can

qui et, emeW att ” °' V " y P°*"‘ -cial needs that are felt

qmie intensely at the present time.

References

Aftee r w T n ‘ al h '° Uh manpOWtr lrendS ■ New Y ° rk; B “C Books, 1959.

9M5 psychology in the sixties. American Psycho, agist, 1963, IS,

12 .

training for new
professional roles

r j

. dicated, the psychologist who is

Obviously, as preceding chapters ave programs is assuming

creating and functioning in commum y P F ^ r the most part, clinical
a variety of roles that are entirely new ^ fi e id Q { community psy

psychologists have taken the lead in t ie emp hasized diagnosing and

chology Traditionally, their training^^ ly been practiced on a

treating behavior disorders Therapy oup approaches have grown

one to-one basis, although in recent ye ^ psyc hoIogist who has led

t£5S5^Tnce Thus the traditional .nil H , argdy by the med.cal

the way in community psychology ' suc h as sociologists an so-

model Although other professional F 1“^ comm umty forces, they
otaT. psychologists, have been conce ^ “ ni1prstand , ng these forces rather
have bee n Interest ed in researching an refore> who would enter com
th an in a ltering them /or virtua y » ■ entirely no vel roles
muni ty psychology, it is necessary 357

336 / criticisms of changing mental health approaches

Community psychiatry Garden City, N Y Doubleday, Anchor Books, 1969
P P 31-57

Rosenhan, D & London, P Character In P London 8: D Rosenhan (Eds),
Foundations of abnormal psychology New York Holt, Rinehart & Winston,
1968 Pp 251-289

Sarason, S B , Levine, M , Goldenberg, I I , Cherlin, D L, & Bennett, E M
Psychology in community settings clinical , educational, vocational, social
aspects New York Wiley, 1966

The President’s Task Force on the Mentally Handicapped Action against mental
disability Washington, D C U S Goiernment Printing Office, 1970

Ullmann, L P , & Krasner, L A psychological approach to abnormal behavior
Englewood Cliffs N J Prentice Hall, 1969

Zax, M , 8c Cowen, E L Abnormal Psychology Changing Conceptions New
York Holt, Rinehart & Winston, 1972

GENERAL RECOMMENDATIONS FOR COMMUNITY PSYCHOLOGY TRAINING / 339

phases (Reiff, 1970; Roen, 1970; Levine, 1970) . This shift in emphasis
calls into questions the value for the community psychologist of much
typical clinical psychology training, especially that portion devoted to
theory, individual diagnosis, and one-to-one psychotherapy. As Levine
(1970) states in discussing the new community approaches:

“The relevant theory has to do with group dynamics , with concepts
such as role, with the study of institutions and organizations, particularly
as these involve the control of deviancy, the study of the goals and va ues
of a variety of social institutions and settings, the organization of helping
services, the introduction of services into ongoing systems the develop-
ment of new service organizations, and the concepts of socia an ins t
tional change " (Levine, 1970, p. 76).

How, then, should the new community psychologist be trained?

GENERAL RECOMMENDATIONS FOR COMMUNITY
PSYCHOLOGY TRAINING

The purpose of the Boston Con ^“ j^^whichToften regarded
Cooper, Hassol, Klein, and ' ^ as t o discuss training for

as the birth of modern community P S I C JL mental hea!t h work. Un-
psychologists preparing to go into co developme m of community

derstandably, at such an early stage t0 support a narrowly

psychology, conference participants w , was considered to be

restricted training model. Community P* y ^ of any ty pe 0 f training
too poorly defined to permit the psychologist, and partic-

program. Clearly accepted was the i ‘ like j y t0 be drawn into
ularly the clinical psychologist, w o ™ as . greatly and to become
community work, needed to broa en is ereto f ore . The psychologist
much more of a generalist than he a tQ neec j input from many

who would function in the community wa fragmentary knowledge of
of the social sciences, and recognizing t jj at be should remain re a-

community psychology functioning, it w aches The ideal role or

tively open to new concepts and «• "participant-conceptualizer.

the community psychologist was that ^ j . processes, the psychologist
Thus, while he is embroiled in com VP ^ fnunework . This en-

must also conceptualize su ^ P roce * ; ts bootstraps. . , ,

tails, in a sense, pulling the field up by , widely- Recognizing that

Discussion at the Boston Conferen 5^ from clin ical P^ ydi0 ^'

most community psychologists were j basic training in c mica P .
— * • deemed the necessity of fcU that ski Us acqu.red

one major issue concerned t i ^ some

chology for community mental e

338 / training for new professional roles

While it is premature to assemble an exhaustive list of potential new
roles that may be required of the community psychologist, several general
classes can be identified. Spielberger and Iscoe ( 1970 )__hav&_d gscribe d
three functions that community psychologists have performe d, in recen t
years* mental health consultation, participant concep tualization , and
serving as agents of social change. Although these functions can be dis-
tinguished one from the other, they are not mutually exclusive so that, in
a given program, a particular individual may function in more than one
of these roles.

In the role of mental health consultant, the psychologist is primarily, 5
resource for assisting community "caregivers” (Caplan,~~Tffij3) , who ar e
themselves professionals in a position to assist communit y me mbers^ in
dealing with various stressful situatibns, but w ho hav e little mental hea lth
training. Various types of consultative roles are discussed in a previous
chapter.

The participant-conceptualtzer’s role requires ,the_ment aT h^nlth .pr ofes-
sional to “help community leaders analyze and clari fy mental he alth
problems in terms of social system variables” (Spielberger and Iscoe,
1970, p 233) . Once the problem has been 'defined, t he community psy -
chologist may revert to the role of mental health con sultant and thereby
elp in formulating programs for coping with it. An important jrequire-
ment of the participant-conceptualizer role is the capacilylta_anticipate
long range consequences of problem solutions. Historically, mental health
problems have been addressed after-the-fact, with solutions directed at
the immediate situation but lacking perspective on potentially adverse
ong-range effects To take the necessary long view, the participant-con-
ceptualizer will very likely need to integrate the knowledge of a variety of
areas such as community organization, sociology, urban planning, eco-
nomics and political science in solving problems. As a pa rticipant-con-
c|ptual 1 zer ? one_must also anticipate the potential thr^Tthat any ionova-"
tive soiuuon to a problem will havener established co^Wtfbu^ts.

i through his professional activities, attempts to
* OC1 ^ - s y® tem »_he_is^fu nc tioning as a social chang^agen€~Tntlie
s^ke tn ri , P ^ ol °P st trl « IP help caregivers Tro ridr bett er

community il?r S ’ * part . 1Clpant ^?nceptualizer he attem pts to h elp

that he has identified 1 A nuS oVaT ~ stc P s - to 59*™2.I^“2 n
v : om r |i, n(prc t . . ' umber the programs described in tfiepre-

nrofcsstnn 7 ^ inVOlVe e(f0rts on the P a « of mental health

professionals to serve as social change agents

™ters have pointed out, the essence of community psy-
chology is an emphas.s on the significance of external forces as a determi-
nant of behavior in contradistinction to the traditional intrapsychic cm-

CENTRAL RECOMMENDATIONS FOR COMMUNITY PSYCHOLOGY TRAINING / 341

as relevant bodies of knowledge and skills developed these would have to
be transmitted to undergraduates as well as to graduate students

In his discussion of the training requirements for mental health profes
sionals entering the community field Cowen (1967) like the members of
the Boston Conference recognized the difficulty of delineating the specif
ic form that training programs should take He pointed out that relevant
course work is not yet well defined and furthermore that the field lacks
sufficient identification models to make the necessary learning C01 ™-
alive He foresaw that the development of new training programs mou
be a drawn out process in which mistakes would be made and leading
would have to come about through experience A signi cant pom
in Cowen s discussion was that even in the best pro^am that might
evolve it would probably not be possible to P re P are pr£ j, Tilled upon
full spectrum of situations and chalIe "g^ tl ^ t ™ 440) However

to face m their subsequent careers (Cowe P , , the

Cowen asserted that a sense of and the estab

proper way of functioning a focus on ^ t he new and

hshment of a general set P^P^^^JsionaHrammg for community
unexpected should be common to all pro

psychology community psychologists

Retff (1966) in d.scussmg ‘"‘ ‘" expressed the need for a per.
and the retraining of clinical psycho g P programs He

od of exploration before specifying the " a n( j ot her social scten

favored meetings between clinical psyc £ stress ed the significance of
lists bringing together professionals ' behavior He also favored

internal and external forces as detenu base decisions He

empirical studies to generate data on w ic commumty me ntal health
suggested training social psychologists to sgtti to determine which

work and to experiment in various types j hea i t h program Avoid

would be the best base for a commum y Reif f dld take a stand

mg the issue of specialist versus genera is generalist the versatile

for training for versatility Instead ot Dei g q£ techntques m

professional would be capable o a PP j ater discussion of training

keeping with the needs of those he ser V developing a body of theo-
needs Reiff (1970) stressed the neces y f commlin ,ty psychology as
ry and a set of practices that couM *st "g „ f thc parameters

a separate school of psychology Wit . „ a body of new knowledge

of a new field as a first step towar ^ developed

he^could not see how training progra prin ciples to guide the eve op-
/Golann (1970) has recommended D ^ 0 ^rams Tlie first concurs ««
merit of community psychology trai ^ cra ] 15ts ra tlier t an po-

lice Boston Conference recommendation

340 / training for new professional roles

through clinical training were essential for many aspects of community
psychology, others feared that the clinician’s emphasis on individual
pathology might impede functioning m community work Conference
participants tended to agree that the community psychologist required
doctoral training and that such training was best provided m university
settings With respect to program content, it was generally agreed that the
sociological aspects of psychology merited greater stress and, correspond
mgly, that the traditional clinical emphasis on neurological and somatic
knowledge should be deemphasized Areas such as social system theory,
community organization, city planning, biostatistics, consultation meth
ods, human ecology, and epidemiology were frequently stressed as neces
sary

The necessity for field training for the community psychologist was ac
cepted by all It was agreed that this training should include participation
m consultation, group programs not typically found in clinical intern
ships and community action programs There was less agreement about
the place of training for patient care m these field programs Thus, once
again although the conference encouraged the establishment of a new field
m psychology, it was ambivalent about the prospect of cutting the emerg
ing specialty off from its clinical roots Another base in psychology that
t e conference participants seemed most reluctant to abandon was the re
search tradition Community psychology was considered to need scientific
inquiry and a readiness to test procedures objectively to become estab
lished on a firm scientific footing

The Boston Conference participants explored the relative merits of
specialist versus generalist training and rejected the concept of a highly
eveloped specialist The developmentally primitive stage of the field of
community psychology was viewed as discouraging ngidifying profession
at roles or training patterns Instead, it was believed that a broad outlook
on the place of man m his social context and the introduction of a variety
pra “ lces for baling with man’s problems was necessary
°P'' d for a shlft front courses based on subdisciplines in psycholo
the varw 3 tralmn 8 P ro gram focusing on necessary social changes, and
Diver " fie d PI 5 rO S m,ght * USed to >™g ‘hese changes about
problmf * br ° ad 5am P h "S °f ‘°c.al s°“ a >

preparation for such effort?” C ' ,en ‘ ele recommended as °P timal

seneas^emTr' 7 T” 5 tra,ni "g Program directors who could
mandate for ‘ nvolved ln soc,al s y«em change was stressed The

mandate for such leaders ,s to convey an "ecological model" and to pro

can ollowT‘ nng mn ° ( Vat,ve ec °logical stance ’ against the sterility that
the process of institutionalization Many recognized, too, that,

GENERAL RECOMMENDATIONS FOR COMMUNITY PSYCHOLOGY TRAINING / 343

tion, oriented toward urban problems, would essentially be a service com
mune Two or three senior staff members and, perhaps even their fami
lies, would reside in the center along with approximately 20 others, most
of whom would be graduate students The graduate student group, drawn
from a variety of disciplines, would include, besides community psycholo
gy students, sociologists, law students, city planners, economists, e uca
tion students, medical students, and the like In addition, some places
would be reserved for indigenous workers as well as a journa ism s u en ,
an artist, a poet, or a novelist This type of mix is sought to guard against
the insularity that characterizes many professional groups

Each resident in the center would be response for tdentif ing
••problem m l.vmg” m the area served, and for creating a program to < deal
with that problem Resident staff would be specie ® umty
student to treat each program of this h fce P P a broad

through which a speciffc ameliorative app ^ wou](J be lept t0 a

er conceptual framework Course work f t ics and research

bare rmmmum, perhaps, indudmg only courses examinatl0ns tes t,ng
design Students would be certified p graduate department

their knowledge of a set of readings spec, bc y (hr( , ( ,^ (penen ces provided
At the heart of the training program w mmar where students

at the training center itself The first would be a «»< faculty w „h

would present their ideas and discuss t cir - itb by ,] le group would
expertise relevant to specific problems grapp £ or the sem mar, but

be invited to speak Course credit wou "° d “ nt5 at t h e training center
participation in it would be require °‘ the i,f e situation
to make intellectual exchange a vita aspe some combination of

The second basic training experience w ^ experience would be

group sensitivity training and psyciotie p members Hopefully,

designed to assist in the self deve °P" ie ” d e 0 f one's personal impact
this experience would provide an un er f or one in tending to lea

on others, for Levine a vitally necessary

community programs writer would be a regular meeting

The third training experience at the jn ll{e within the institution

devoted to dealing with the prob cms a | lCy decisions, in allocating

All residents would participate et l ua . problems of maintaining an
the centers resources, and ,n the eve ; w01 , ld have the opportunity
caring for the building Thus, every t(ers ,i, a t beset any l ea er

to handle the mundane administrative centcr „ould be

Graduate departments sending fjenu no feedback would be tod
quired .o do so with the t'^ff^nfs progress without his consent^
coming concerning an individua s dents on the basis o

The institution's residents would selec

342 / training for new professional roles

cialists should be trained The second recommends that training expen
ences should include collaboration with different professionals such as
educators, political scientists, psychiatnsts, and sociologists The third
specifies that training for consultative roles is necessary Fourth, Golann
indicates that a basic knowledge of social systems and the expenence of
being a participant observer under a supervisor’s tutelage in more than
one of the several systems is desirable Finally, he recommends that the
community psychologist be trained to evaluate mental health services
Roen (1970) makes a number of recommendations concerning opti
mal training in community psychology, most of which relate to practicum
experiences He recommends that students be exposed early in their
training to as broad a range of human problems as possible For Roen
the ideal training facility would adhere to the neighborhood service cen
ter model rather than to a medical clinic model, and would be operated
by the training institution itself This facility would be affiliated with
a specifically defined community that would be studied historically, topo-
grap ically demographically, and clinically to provide a data pool in the
context of which the personal and social problems of community mem
lers cou e best understood Community psychology students would af
hliate with this facility as soon as they entered training Their activities
and experiences would be graduated so that in the early stages of training
in? , I o}? 1 Sim f ly assume the role of case administrator ’ for as many as
, . cases ■" thls role they could become familiar with a client early
ns inta e p ase and serve as his ombudsman by contacting him
wa , J? t0 ° U . r times a year to che< * on how a particular intervention
and a i j l , W ° U ^ P rovi de both a quasi administrative experience
treated °rwi, U ma i P ers P ectIve on what happens to people who are being
calls nr t-p d Cr y student experiences might include taking the phone
“ ? tters presenting the earliest contacts made by the

course TnrVd faC1 « ty LatCr ex P erience s for the student would, of
lems * 1 C S ^ >€C1 C contact Wlt ^ clients with respect to their prob

'I am ‘ ns £ac,llt5 ’ wouId conduct conferences deal

reievam tra,n,ng fo t

service programs - Levine < 197 °) has ****
■mage a model commumty psychology msutuaon H.s ideal mstitu

SPECIFIC TRAINING PROCRAMS FOR COMMUNITY ROLES / 345

SPECIITC TRAINING PROGRAMS TOR COMMUNITY ROLES

Specific training programs for community psychology have emerged in a
number of different settings around the country These programs may be
classified, as is done by Iscoe and Spielberger (1970) , into those that
have been grafted onto already existing clinical psychology training pro
grams and those that have developed m multidisciplinary settings Com
munity psychology training in clinical psychology programs is an attempt
to make clinical psychologists broader, more versatile practitioners Typi
cally, community training is only one segment of the total program for
the fledging clinical psychologist and is often provided after some of the
basic clinical training is completed Clinical psychologists are prominent y
present in multidisciplinary programs but are joined by graduate students
from other areas such as education, sociology, psychiatry, nursing, p
losophy, and even law and business

Training Within Clinical Psychology Programs
The Program at George Peabody College
The community psychology program at ^

(Newbrough, Rhodes, and firs’t^d m" that was incorpo
nar m community mental health first o , _iral psychology

rated the next year into the doctoral sufh

From its modest beginnings in what w ^ ^“/developmental
programs the Peabody program has pa ° d out wlth a primary

phases Phase I. lasting from 1957 to ^ s em,„a r format Top

focus on presenting content areas t h g commumty psychology, con

ICS such as the major historical influen H^rstanding the community,

ceptual models of community psychology, un ^ ere covere d Midway
and methodology in community psyc ° set U p t0 augment class
through Phase One, practicum experiences ' being consultation

room content, with the major practicum ^ course designed to teach
Practicum experiences were coordinate ' , n pr0 cess Field agencies
students about various aspects of the con *| nursery schools, pmate
used for the consultation program 1 * lC program in a housing P ro J
schools the welfare department a socia ' v a nei ghborhood com

ect the detention center of a juveni e c ° ' j nn g experiences, students
munity center Prior to engaging in these superv ,sion through Mork

were given experience in administration am* ^ Kam " a p

with other graduate students m w 1 f our to six students at vary

preach Teams were set up cons.st.ng of from

344 / training for new professional roles

and each new resident would begin on a probationary status until the
group decided whether or not the program was a suitable one for him
Once admitted to regular status m the program, all decisions about a stu
dent s continuation would be the responsibility of the group Individual
members would be encouraged in their own growth but, if the decision
were reached that a person was not functioning well in the group, it
would become a group responsibility to find a suitable alternative place
ment for him

Levine emphasizes that such a training center must be financially inde
pendent All too often he fears that those who provide funds attempt to
exercise control over an institution’s functioning, so that there would be a
serious danger of having the goals of the center subverted by its financial
supporters Ultimately, he envisions that the best way to ensure the integ
rity of the institution and its goals would be for a portion of its funds to
come from those who are served by its programs, which has the added
advantage of helping to guarantee the relevance of programming

Within the center s general service mission, each individual would ide
ally have the ultimate responsibility for any program that he develops
All decisions with respect to that program should be made by its develop-
er with center residents exercising only an advisory role Although some
group control would prevail since the allocation of funds would be a
group decision a resident would be free to seek funds from outside
sources in instances where he disagreed with a group decision that might
limit him

This survey while not exhaustive, represents much of the recent think
ing of some of the more prominent figures in community psychology
about training for work in that field Unfortunately, the dominant feature
in all of these recommendations is vagueness Agreement with respect to
certain general issues is evident, but specific guidelines for reaching de
sire goa s are lacking All seem to agree that a readiness to be innova
tive and flexible in coping with human problems is a prime requisite for
the community psycholog, st Many speak of the need for training a gen
Those who P ro P°se specific programs such as Roen and Levine,
peak m visionary terms not readily translated into practical programs A
‘n“° n ° 1 C maj0nty o£ these ^commendations is that they
details f w° me 8 en cral directions while they ignore many practical
nrob blv * eaU " lth ln d ™ lo P'"g specific programs Tins ,s

made than * ' C1Sm ° £ <lle 8eneral rec °mmendations that have been
lee . ,S 15 “ CO r em °" the nascem sta ‘<= ‘he field At such a
neft 1, ' a 3 ’ “ ,dealmic ter ™ and m broad generalit.es The

which (I 1 ? consl ers several examples of extant training programs in
which developers have had lo work through a variety of practical issues

SPECIFIC TRAINING P ROC RAMS FOR COMMUNITY ROLES / 347

hours are devoted to a seminar in which students’ experiences are re
viewed The most elementary field experience involves the study of some
aspect of the local community Field work is spent in collecting informa
tion, with the assistance of a community volunteer, for a report on the
particular aspect of the commumt) under study A second type of place
ment at a higher experience level involves consultation to a particular
agency or program under the supervision of some staff member, often
not a psychologist, m the agency The third field experience at the most
complex level requires participation in a program evaluation or research

project in the community ,

Another significant development in Peabody s third phase has been the

development and articulation of a Center for Community t u ies

center includes faculty from departments of sociology, ps> c 0 °o^
psychiatry from a variety of colleges m the Nashville, ennessee area
and has become affiliated with many centers and schools equipped t
make relevant contributions to the centers functions ese " h []je
elude primarily descriptive ™ J ^“; l “ coordinator for

Zr^ch”en™Tpos,«,on to prov.de community field expe
nences for students as well as paid research assistants ips

The University of Rochester Program
Cowen (1970) desenbes the community “'"“‘^“’'^^ofRoches
has been introduced in the clinical program a commu mty psychology
ter In this program some didactic materials ““ “““^. the primary
are introduced in an early seminar in psyc op ' umm usual

vehicle for community psychology training 1 n g On the average

ly taken when the student is in his fina year community mental

a student spends about eight hours per week in his

health practicum uhich the student is as-

Unlike the typical psychotherapy P rac 1 cornmun ity mental health
signed a certain number of patients 1 ^ to address specific pro-

practicum a senes of programs are con students are assigned

blems found in the local community an yp ^ While the stu
in pairs to programs m which they a ' program he is expected to

dent’s pnmary responsibility is towar uire extra manpower us

assist in the functions of others w T . nnnro fessionals or in helping wi
he may assist m screening prospective r ^ in g in a program other t an
the training of nonprofessionals w o a a j so broadened throug a

his oivn The individual students train g ^ ^ parllC iirn Here

weekly meeting held for all ‘ ' S ‘ U infonD aUon and chew over curr
students and instructor excha g
problems

346 / training for new professional roles

ing levels of training. Each team functioned as an independent clinical
staff with specific service responsibilities at a child study center. In each
team a third-year clinical student took the major supervisory and admin-
istrative responsibility with the assistance of a faculty member. Thus each
team member, when he advanced to the third year, came to assume an
administrative, supervisory role.

Phase Two of the Peabody program, a brief one, lasted from 1964 to
1966. Some broadening of the original program took place during this
period as the result of research study carried on by one of Peabody’s fac-
ulty members. This study was devoted to describing patterns of discord-
ant behavior in a high pathology neighborhood, and to studying ways in
which the community dealt with its problems as reflected in the action of
its agencies (the church, courts, welfare, schools, and the like) . Among
the by-products of carrying out this study was the increased contact
among the participating agencies. A second important yield was the es-
tablishment of a neighborhood counseling center as an extension of an
existing mental health center in Nashville. These developments were rele-
vant to the community psychology program in two ways. First, they made
avai able a resource through which training in community research could
e provided. Second, and no less significantly, the interdisciplinary group
that was brought together for the purposes of carrying out the study
.found n worthwhile to remain together once the study was completed.
This group formed the nucleus for the eventual establishment of a Center
for Community Studies at George Peabody College. During Phase II also
occurred the extension of the community psychology program into small
urban communities having limited professional resources, and its further
extension to consultation with community caregivers such as nurses and
ministers. °

b elr n' 1 ' 6 I" 051 recent P- lasG °f the George Peabody program,

a ! 9 G ’.^f community psychoIogy program was developc d as

dcnartmc mtlun the Psychology department coordinate with other
S’— pr0gram , s - U stm twined most closely related to the clini-
mL,ai nrIrC Sram , m a ™ labl * indents in other depart-

chology^ and the m as counse | In g. school psychology, educational psy-
trainimr In ., 1,1 v ° !V°. c ° ud benefit from community psychology
psychology program s' ‘ft ' 5 lnl c P endc ^ t status provided the community
Presently tnininv •' 1 I» an °PP° rtlln,t y to develop its own unique form,
in alternate v,--, r , ° dy 5 P ro 6 ri >m includes two seminars given

Health " and "Co . An Intr °duction to Community Mental

1 don there n " 1 '" amI Community Development." In ad-

...ret! L™ 0r , ll ' rC = “> Reid placement semesters strut-
ment from fn.fr , ^ f' ° ' ‘ C s,l,dent ’ s experience. In the field place-

ment from four to sue hours per week are spent in the setting and two

SPFC1FIC TRAINING PROGRAMS FOR COMMUNITY ROLES / 349

Gradmte students in tlie program served as supervisors and resource
people for groups of six to eight undergraduates and met with their
groups immediately after each session between volunteer and child

A second project through which University of Rochester clinical stu
dents received community psychology training was based m the settle
ment house This project involved setting up a counseling program or
to 8 year old children using M to 17 year old indigenous youths as
counselors The program was based in the settlement house an t e sta
of the agency referred youngsters to the program on the basis of their
knowledge of the youngster or his family situation and a so participa e
m helping decide ihoi.t counselor child pairings Graduate students^ 5
lected counselors trained them and then monitored their "

the program through i series of regular meetings t at were
week following periods of interaction between a counselor and the child

to whom he was assigned _ , . ,,.-1 u>nlih

A third type of program ,n the public schools It

Practicum used retirees as mental health « Y voun g

was felt that retired people had considerab e poten »
children struggling to adjust in the schoo system J ^ b ^

filed by being useful to others Graduate studenu i partly ^ ^ ^
ceptuahzing this program consuUing with the ^ impkmente d the
lecting recruiting and training the re schools Retirees

program and supervised the aides func i gi(Jes and one gradu

worked three and one half days per wee wi were acquainted with

ate student being assigned to each sc mo youngsters who

the availability of the aide in the school to deal w mdu(kd

might need contact with an intereste a and conversation In

helping with school work play activi l * related to their own areas

many cases aides introduced specia ac 1 ned close contact with

of expertise or interest Graduate stu health and administrative

the a£es and served as liaison to school menial

personnel onrhester program have included the

More recent developments in the R V undergraduates that is

establishment of a mental health P” C “'™ nt WIt h the didactic portion
taught in part by graduate students Concum tnt m a vane ty of Be d

of the practicum undergraduates a the local school system n

settings including a local state os P* , _ it are supervised by the gra u
these settings they function in program

ate students r ,

Community Psychology at t HeCUyCoUe g eo,tke

University of New York ommunity psychology naming

Singer and Bard (1970) '"“hology naming program which
procedure that is part of a c

348 / training for new professional roles

In any given year the programs serviced through the community men
tal health practicum are, in part, holdovers from previous years, pro
grams initiated by an earlier group that have, to some extent, become in
stitutionahzed and, in part, new programs being introduced for the first
time Inevitably, the new program requires broader participation on the
part of the trainee, since routines have not been worked out and many
unanticipated problems must be faced The established program tends to
require only the energy for looking after current program operations and
possibly, the refinement of some details of the way the program has been
run in the past, with relatively little opportunity for creative, conceptual
problem solving Ideally, therefore, optimal training might result through
the initiation of entirely new programs each year In the real world this is
not practical however Existing programs may be treating real life prob
ems for important segments of society and must be maintained, especial
y if their existance has potential for modifying an ongoing social system
in a beneficial way Another reason for continuing with existing programs
1S i? fC ? ne tbem so tbat ^ey can be improved over a period of time Fi
na y, t ie problems associated with mounting entirely new programs is
extraor manly complex and the task of initiating many at one time may
well be too impractical within the framework of a practicum

major advantage of having a variety of programs conducted concur
y a °ug wit the regular introduction of new programs is that the
rr!lff C ° meS aUUn 5 t0 ^PP 111 ^ with different types of problems in
flexihl * ^ ent WayS TIUS may be tbe best way to 11-3111 students for the
aP ^ ll ° n l ° thC Varymg demands new situations that Reiff
(1966) regards as essential for the community psychologist

Jr” 10 " ° E f the Vanety of social Problems addressed m the Roches
some of lb/*™ ^ Cnta , Healdl practicum can be provided by specifying
nence One ha^T™ J 1 *'* been °P erated throu gh this training expe
school children i ° ^ Scllo °* day program for primary grade
from adults tin™ *° referred teachers as needing more attention
proTide m ere ^ pr ° V,ded m the ordl "ary school situation To
gSSe pra?ucf,m “ “T"' 0 " 5 f ° r these V-ngsters, members of the

-ong college students
target groun a, a, L™ i » f V cleme ™ary grade level This \olunteer
be capable of mectine ms °' 't '' causc u se «ned like a group that should
dren as well is heme t° t !C cmol '° nal ar >d cognitive needs of chtl
r„ ernotionrllj^nced) ***’ ^ ^

<"11, sdiat could be le^ed ,n reH ^ C,aSSroom “”««> IIo P c

bancc the classroom eft alln E lo ’be troubled child might cn

a teacher ^ctisencs, of the volunteer once he or she Eecamc

child ssnh'sZr, l *' C ,lnilcr E ra duatc 'oluntecr was assigned to a single
“ h " 1,0m he m “ for on ' on each of tno afternoons a neck.

SPECIFIC TRAINING PROGRAMS FOR COMMUNITY ROLES / 551

aware of how the personality of the individual client must be understood
in the context of the client's specific community
The City College clinical program provides general training at the pre
doctoral level Its organizers have felt that specialty training is better ac
quired postdoctorally However, in its attempt to provide a good broad
general base in clinical psychology, the program does stress a develop-
mental orientation This orientation is reflected in the sequence of courses
and training experiences offered the student in the three years of t e pro-

gram , ,

In his first year, the City College student takes course work and has
practicum experiences that stress the developmental cycle from childhood
through old age From eight to ten hours per week are spent m t e n
versity Psychological Center where the student observes and rates the be
havior of children without any prior knowledge of the child . back
ground Once experience has been acquired in systema ica an[ j at
behavior the student reads the case material ’^Job^at.ons Another
tempts to relate background experiences to t e eac j l stu

important feature of the first year prop™ « » 1 there are ^dpar

dent to a three generation family— a tami y Students

cuts, parents and children all hving ^ ° an d to observe

are expected to meet with their family o m duate school,

them systematically over their three yea nr1 . n i tatlV e services Another
and to provide the family with advisory or „ of all stu

significant feature of the first year P r °f ml dway between a T group
dents m a group situation described a b ded ]nt0 t „„ groups

and group psychotherapy y hefi " ty ” r „ 5 sessi0ns with an experienced
each of which meets for from 20 provide an outlet for the

group leader This experience is u vea / of graduate school and to

anxieties normally associated with t e community that will

be a model for later consultation experien

be part of the student's work j nracticum assignments focus

During the second year, course "°' k *J ent student s do intake m
on diagnostic testing and persona 1 y latter half of the seconc

terviews at the Psychological Center, an ^ m t h e psychotherapy

year, as didactic materials are being P « e sttl dents In their con
course students begin to counsel trou r stu dent is an advisor to

sultative functions, the City College se d to prowdc tutoring xn

an undergraduate group at the college Here the dm, ml

ices to local Negro and Puerto Rican n g the cognitive capaci

student's role ..to prov.de tead-mg technique., and

ties and limitations of the children uncertainties concerning

to help tutors deal with their doubts ami

efforts

350 / training for neio professional roles

stresses many traditional functions. The primary focus of the community
psychology thrust in this program is training for consultation. As de-
scribed by Singer and Bard (1970, p. 128) :

" Consultation involves a contact with either an individual or a group
and has as its function the preparation of the client for some more effec-
tive activity in the amelioration of difficulties in living for some other per-
son or small group. This consultation is not ordinarily a matter of formal
teaching, lecturing, or advice giving. It is essentially a clinical contact in
which the client's emotional stresses, cognitive distortions, or other per-
sonal difficulties are dealt with, using the best knowledge of individual or
group interaction techniques available ”

The view of consultation as the application of the consultant’s clinical ex-
pertise to the consultee’s cognitive or emotional problems is relatively
narrow compared to the consultant's role as described by Caplan in a
previous chapter. Singer and Bard’s conception of the consultant’s func-
tion is also not far removed from the traditional role of the clinician, and
avoids the broader activity of system change and the creation of entirely
new service programs.

Another essential focus of the City College program derives from the
belief that our society’s increasing complexity and mobility requires the
establishment of neighborhood psychological centers to help provide indi-
viduals with a sense of affiliation and a feeling of community. These cen-
ters are envisioned to provide a variety of services to the community in
which they are located. In addition to traditional diagnostic and treat-
ment services, neighborhood centers are expected to carry out ecological
research assessing community characteristics, stress points, and the like.
Consultative services to community leaders, architects, and urban plan-
ners in connection with community projects would be another potential
neighborhood center role. Agencies or groups not customarily benefiting
from mental health support such as the welfare department, police de-
partments. visiting nurses associations, boys clubs, day-care centers, unions,
am t ic public schools could also receive consultative services. In
keeping with this imagined future role for psychological service centers,
s “dents in the City College program are exposed early in their training
r iC T rat, ° n ° E 3 11 » i versi ly-spon sored psychological center that oper-
nn w li" a c,rcinm . cr,bcd comm »nity. Considerable emphasis is placed
i ,c community must be studied and understood to optimize the
dMdr, C T " iVC WrviCC5 ofrcrctl b >' thc clinician. An impotent
."! Sl ' C 1 a lrr " nm K experience is the realization that the clinician
cannot s.l by passtvely waiting for patients to come to him. It is hope.)
tnat he will recog, „re that he must he more active in communicating with
community members at many different levels and that he must become

SPECIFIC TRAINING PROGRAMS FOR COMMUNITY ROLES / 353

spends most of its time away from the clinic in other people's settings de
signing and operating various types of prevents e programs Specific set
tings in which staff members work are presumably a function of staff in
terests and the potential host’s cooperativeness Institutions and agencies
such as the elementary schools, the junior high schools, aspects of the lo-
cal community action program, and regional centers for the mentally re
tarded have been sites for many of the projects emanating from the \ a e
Psycho Educational Clinic Formal characteristics of programs vary de
pending on where they are based, but they often include consu tation
services and group approaches to dealing with the pro ems o arge
numbers of people Pre\ention is a major goal throughout, an in
with this goal there is considerable concern with the way m w ic
zational structures often tend to be self defeating an arm u
major purpose of the Yale Psycho-Educational Clinic is to sen .
hide through which faculty members having broa y simi ar ai
their prevention theories in practical settings where personal opinions

may be altered or bolstered through e “P'" ca ’ Psych cEducat,onal
One full day each week is set aside at differ

Cltmc for bringing together all faculty “ meeting, and a meet
ent activities a clinic wide seminar, . a f Y ^ ^ seminar and th( ,
mg with an outside consultant on gTO P P f ing for

group process meet.ng represent the most f ^ al aS ^ any , c as „„
students The seminar is a general meeting ope ^ broad range of

fit around a large table, typically a maximu theoreucal issues

topics are discussed, from research stu ies e st experts are fre

Any participant can suggest seminar topics. ^ umieraty At umes,

quently invited both from within an an( j some meetings are

the faculty and students present their °” n 1 * characterized by spirited
left entirely agendaless These semin ^ a nd re partee ’ Outsiders
freewheeling, interchanges not devoi o • (he inte ms, afford

participating in the seminar usua yjm ^ usUors
mg students considerable personal c demoted to group proc

The other meeting attended by c * nic r m , nar focustng on theoretical
ess Originally established as a di actic discussion groups, some pres
and practical issues related to therapy an ^ study and away

sure has been exerted to direct group e development of two factions
from ns didactic aims This lias led training and die

within the group one preferring to emp %cn the status differences

other regarding this as an imposs 1 ® j l3S nro\ed to be use u in

between group members Tins < l5a & tl ie clinic organization iix an
pointing up to all group members „ functions

the conflicts demmg from it can effec pre-intern. graduate ye*

Students can tram at the clinic during the. P

352 / training for new professional roles

In the third year, the graduate student carries a case load o£ approxi
mately three cases in psychotherapy drawn from the local college group
The third year consulting program is more complex than those preceding
it A course is provided m 4 small group dynamics and family interaction
process to acquaint the student with the theory and research literature in
the field In addition, three types of consultation experiences are avail
able The first, a parent education project for mothers of children placed
in day care centers involves group meetings including mothers, clinical
students and staff supervisors that are devoted to the problems of child
care In these sessions mothers’ attitudes gaps in knowledge, and envi
ronmental stresses are dealt with particularly A scecond consultation
experience is directed toward teachers in the local school system In this ex
perience, examinations are made of teachers’ attitudes toward the behav
lor of the typical slum child, the cognitive limitations of such children,
and the teachers feelings about themselves, their school, the admmistra
tion and the neighborhood in which they are working The third type of
consultation experience involves work with a special unit of policemen
This program initiated by Bard (Bard and Berkowitz, 1967) is described
m detail in Chapter 10 In this program the graduate student helps to
train police officers in a special family crisis intervention unit that m
tercedes in identifiable family conflicts The students participate m T
groups with police officers and are consultants to them on a continuing
basis Students also do follow ups of families contacted by this unit They
are thus in a position to identify potential sources of serious community
problems and to offer families the opportunity for treatment through var
ious established agencies

Community Psychology at Yale

Sarason and Levines discussion (1970) of community psychology at
Yale is more a description of a training facility than a characterization of
a training program Apparently, the authors consider this facility, the
Yale Psycho-Educational Clinic, and the activities it engages in, as the
backbone of the community psychology training program The clinic, an
integral part of the department of psychology is the setting for certain
pracnca in the clinical training program as well as the internship setting
or Yale students interested in community psychology The core staff
consists of six faculty members and three part time psychologists who, al
hough not teaching members of the faculty, are considered clinic staff
members Faculty members of the clinic staff participate voluntarily,
agreeing to devote a minimum of three days per week to the clinic

Unlike the typical psychological or psychiatric clinic, the Yale Psy
cno-hducational Clime is not open to the general public and does not
take referrals of specific individuals with problems Instead, the staff

SPECIFIC TRAINING PROCRAMS FOR COMMUNITY ROLES f 355

on the pm of the student con be telling Another supervisory problem in
community psychology is tint it is often difficult if not impossible to ar
range to Ime the faculty member observe the student When both func
non together in a given setting it is virtually impossible to disguise ,
fact that one is a student and the other is a faculty member and the cli
ent s natural inclination is to ignore the student and direct is attention
the faculty member . , , ..

Not haung an opportunity to observe a stu ents wor **
faculty is forced to rely heavily on the student s report of his funct 10 m g
Reports can be solicited from the people with whom the student « work
mg but these are often biased in one way or anot er ™ n _ to

informants may not wish to say anything they ee mig h

the student because they like him In other instances a
siderable competence and drive for “^"^“^qoo Without a fairly
agency workers who prefer to ma,nta ' n *, dl ft cuIt t0 find ways to

accurate assessment of student perform overa ll effectiveness

correct faults to reinforce strengths or s r e po rts is the su

One major asset in achieving perspective setting where the

pervisor , experience of having worked himself m “‘“f* the back
student has been placed This ta ™ ,l ‘j' r ““ n evaluate what the student
ground of the situation against which

reports h Y ale psycho Educational

An important supervisory technique of suc h group experience

Clinic is the use of group supervision nmva i e nt experience level and
includes only interns or students on an eq ^ c ] inic director may

the clinic director In group sessions o i are at 0 dds with those

express opinions or suggest courses o aC 1 can be use d to reflect alter
of an immediate supervisor Such i ere . han as bases for resisting

natives based on theoretical differences r gs are use ful in shedding

supervision Within that framewor tie . s £ orm 0 f group meeting is
light on basic issues In a sense there or ordinary supervisory re

an antidote to the authoritarian struc ^- oup meeting is that it provi es
lationship The second advantage oit f * oup among whom com
the student with a sense of belonging l °“^ m f can be achieved Third
pansons can be made and with whom J mty to , e am what others

these meetings provide students with with different set

are doing in similar settings an °

UngS at the University

Community Mental Health Traini g

of Colorado ce w as initiated in 196

The University of Colomdo to provide a ”ew^po“'^k

ith the hiring of a single f » sequence of f

.v i /Rloom *

with

within the clinical area

354 / training for new professional roles

as well as for their internship Tor pre intern students, the major problem
in working at the clinic is establishing a sense of identity Typical precon
ceptions about what the clinical psychologist does and what he is sup-
posed to know are simply not confirmed at the Yale Psycho-Educational
Clime intensifying the identity problem to which all budding young pro-
fessionals are subject Of course, a major contributant to this confusion is
the fact that the clinic staff itself is engaged in something of an identity
struggle since its members are moving into what is essentially new tern
tory for the clinical psychologist

For the intern the confusion experienced by the pre intern is duplicat
ed if not compounded The goals of the internship experience at the Yale
Psycho-Educational Clinic are to give the student an overview of what
various human service settings are like, how a particular administrative
organization contributes to the problems it experiences, and to appreciate
eventually the possibility for changing settings Another goal of the in
ternship is to provide the student with experience in several different
helping modalities such as consultation tutoring individual group and
amily therapy the supervision of nonprofessionals program develop
ment and participation in decision making To achieve these ambitious
goa s t e student must be exposed to more than one agency at the same
time so that he can compare different settings and acquire a sense of
perspective n

fnf ?bp St r d ? ntS ° Ut fr ° m under tIle y° ke °f a structured didactic program
come j 3 f er !° haVC an ira P act the real world and to be

cho-F.rh lr w f‘ d , efined profess.onals the expenence at the Yale Psy
“a“ Chn, f ,S Chaotlc and anxlet y provoking at first They
the same time * m 5everal different physical settings at roughly

tus and are virt ]'!' V 316 *>y some as honored figures of high sta

ences t d!ffic r y u S T ed by others Mak ’"S «« out of these expert
these problems L resultant confusion is disturbing Adding to

nencewre not * lnevita |’ le concerns that community psychology expe

SSZtS 1 be * StLa.

by these issues the I, a w,th "° mark « a ble skills If not perturbed

they lack knowledge Y^^ W ‘nh! hat T COmmUmty P*yc h ° Io S““

economics that will be essential to ,h r° P 67 POl “ ICal SC ‘ enCe ^

proE~ £ h^ — presents special

and the ta «f ^ y , tate l ^ e stuc *ent is also frequently angry

sTderedtobe ' - ^ C ° mes the ^ulty member who is con

oftenlakes die r" 6 T eh ° W f ° r ' he a " x .ety The students hostility

q ahficanon SubtIe ° r direct atta ^ on the supervisors

“I ™ competence and ethtcal responsibihty Stnce most faculty

considerable^ , c ““™on.ty psychology field they doubtless suffer

considerable personal uncertainty about these tssues so that such attacks

SPECIFIC TRAINING PROCRAMS FOR COMMUNITY ROLES / 357

welfare services. Nonclinical students were placed in agencies not requir-
ing clinical functions such as guidance techniques, crisis intervention,
brief psychotherapy, and mental health consultation. Experiences open to
all students included activities such as community organization,, wor
with interagency groups, community decision making, and preventive re
search programs for reducing the incidence of mental disorder. Field
placements required 2 one-half days of work each week through the aca-
demic year.

Multidisciplinary Training Programs

The Program at the Harvard School of Public Healt

drawing its students from psychiatry, c it lo the Master of

work. The program involved one year o ra g ^ jn Hygiene
Public Health (M.P.H.) degree or the Ma*^^ ^ students the
(S.M.Hy.) degree. For most “ m y few fixed requirements

S.M.Hy. degree seemed preferable beams se ^ required o£ all stu-
were associated with its attainment. Epidemiology, was de-
dents opting for the M.S.Hy., Biostatis 1 . ,. nes regarded to be basic

signed to present fundamentals of * e at t he community level,

to the study of problems of healt an nroeram were quite flexi-

Beyond this requirement, didactic aspects

ble depending on the student s previous a offerings of the School

Some course work was drawn from the £ Public Health

Of Public Health including examples sue on 0 f Health Agencies,

Practice,” “The Organization and Ad) m Practice of Ma-

■■Factors in Health and Disease ” ^ ICth ;

ternal and Child Health," “The i Hunm" < Oom ^ ^ Cuhund

ods in Community Health,” an ., ear re q U ircd for t lc m ' f

Perspective.” Out of the 40 credit hours pe 5 h ^ready-established

ree, rougniy cv , j ie re

courses in the public health schoo an , hcaltll luF ,„ -----
earned in courses devoted stricUy to jr.e „ Group Dynamics and

Epidemiology of Noninfectious ,se
Control of Mental Disorders.

health topics

In addition to the course work in a scries of held assign-

Scliool of Public Health program P ' P b Q,plan and hn ..

ments at a set of field stations developed^ ^ diverse common,
field stations included three giudan “ ccnlc rs, ctab

ties, one of this country’s original men

356 / training for new professional roles

mester courses were set up to be given one each semester, for a two-year
period Although they were intended to provide specialty training
for clinical students interested in the community area, nonclinical gradu
ate students were also welcomed The courses all given as seminars were
organized so that each could be taken as an independent unit without any
prerequisite

The first course entitled Basic Issues in Community Mental Health
was concerned with many broad issues and programs The topics covered
include historical antecedents of the community mental health movement
the practices and concepts of public health current developments in the
organization of health and welfare services issues in the provision of lo-
cal mental health services the role of the state in the organization and
support of community mental health services and the federal role in the
support of community mental health services The second course ‘ An
Introduction to Community Mental Health Practice included examples
of primary secondary and tertiary preventive programs and examined
various community mental health programs outside of the United States
The third course Epidemiologic Methods m Community Mental

ea t included general material on epidemiology plus reports of spe
cific epidemiologic studies relevant to the mental health field The fourth
course was entitled Research Problems in Community Mental Health
anc covere topics such as biostatistics the methodology involved in
s u ymg ami les material on mental health program evaluation and a
discussion of psychiatric case registers

Because students were interested in making their own contributions to
meulc r U ' m tWO course Precis were developed During the first se
for a i e lnstructor and <:acjl Student independently developed a format
Z Tc™'" 5 l nat,onal m '"‘ al health program Toward theend of the
ule form n i C tv 6 Various 'tidependent efforts were integrated into a sin
fonntrTand a Ur T S i u T°" d semester each Reeled a specific

mester to a stud ' t h ' forInat that had been developed in the first se
Pha e of the tin T' 3 ' health P™8“» of that country The first

cou se iouen- y C ° l0rad ° 'herefore entailed a four

r.aredT,h n the“ Un,ty m<!ntal he3 “ h P lus ‘P«‘ a ' P"*““ as

mnoduceT Th d e °' ^ C ° l0rad ° held placements were

of two rim 1 mmu mty mental health field placement served as one
„ TntTT P n a ? 1CUrn ™' sn ™ ms that were ™P»«d foe ‘he doctorate
comm , r yC ! SV ' ypeS ° £ field P la «ments sought included

cZTT aC “° n Pr0Sr3mS ,n the men,aI health field selected

comprehensive community mental health centers and entire communities
e it was possible to study the power structure and decisionmaking
processes as well as the organization of publ.c and private health and

SPECIFIC TRAINING PROCRAMS FOR COMMUNITY ROLES / 5o9

The didactic side of Texas community mental health program includes
four required courses Mental Health Consultation, Seminar in Men
tal Health,” ‘ Seminar in Community Mental Health, ' and * Seminar in
Community Organization,’ taken at the school of social liork Seieral
elective seminars and courses including Human Ecology and Demogra
phy, ’ ‘ Sociology of Health Services ‘ Cultural Deprivation and Pover
ty/ "Introduction to School Psychology,” and Computer Techniques ol

Programming ’ are also available

Field training m the community mental health program is came
m a variety of settings that have been selected for their relevance to pro-
gram goals In all but one field setting students experiences
Led by nonpsychologists, a strategy that ts intended to broaden the s.u
dent s horizon concerning the community and its su systems

The experience provided in three of the “ S ettings in clude

gram seems to be primarily observationa r an( j p ro ba

the Hogg Foundation for Mental Health the Juvemle Court^nd Pro ,
tion Department of Austin and Travis counties an p oun da

tunnies Corporation of Austin and Travis coun lies Th^gg^ ^
tion, a private foundation administered t roug aJ actl on projects

supports programs in mental health education, ychiatnc studies in

involving the application of behavioral science >» are a ,

practical settings, and the «valuat,on ° ' th em from intake, through

signed to monitor specific projects fo ? nsu ir a tive recommendations

staff review, and acceptance, rejection or c SOD | llStlC ation in evaluat
to the applicant This experience provi es meetings of the

mg proposed projects Students also si , t j icy m eet prominent

foundation's National Advisory Commit jar with mental health

figures in the mental health scene and becom

developments on a national level rn i,ation department acquaints

Experience in the juvenile court an P ^ setting It familiarizes
students with the goals and prob ems ® . n j xut h the duties and re

them with legal problems involving juv t j, e complicated intcrre-

sponsibihties of probation officers ur i j ice department the com
lationship between the school system ™ cc of delinquency becomc *
mumty employment picture, and t ic i

apparent c { Austin and Travis counties

The Human Opportunities Corpora i programs in ihe area

administers and monitors all common > ac l administered b>
Texas’ community mental IieH.h *« ffee .heir

Texas’ community mental new t j, c> face their reia r

the corporation to study the pro cm wlt h community forces

the community, and the *a> coopcrat.o

couraged or impeded community mental Iteahh stm en

More active participation b.

358 / training for new professional roles

Eric Lindemann in Wellesley, Massachusetts, and the main office of the
Massachusetts Division of Mental Hygiene. The purpose of the field ac-
tivity was to provide front line experience in and training for consultation
with professionals around a variety of problems with which they must
contend. It was hoped that through consultation the mental health profes-
sional could have primary preventive impact on the community.

In 1964 the Harvard program was moved from the School of Public
Health into a newly established Laboratory of Community Psychiatry
within the Department of Psychiatry of the Harvard Medical School.
Since that time the program has been unencumbered by the degree re-
quirements of the Public Health School and has offered a certificate to its
graduates instead of a degree. The program continues to integrate didac-
tic learning with field training and still emphasizes the consultative role of
the community mental health specialist.

Community Mental Health Training at the University of Texas
Iscoe (1970) has described a multidisciplinary graduate training pro-
gram in community mental health originating in the Psychology Depart-
ment of the University of Texas in 1965. The program’s purpose is to
provide graduate students in a variety of disciplines with a combination
of course work and field experiences to enhance their understanding of
the community and their skills in dealing with its complexities. Present
methods of delivering mental health services are studied with an eye to
improving them. Impulsive activism is restrained by the program’s em-
phasis on the necessity for winning a community’s acceptance before re-
conceptualizing its problems and introducing new approaches. The pro-
gram is intended to turn out a community mental health specialist or a
community psychologist with a broad view of mental health problems
and an appreciation of the need for relevant behavioral science research
in the community.

The Texas program accepts students from psychology (social, person-
a lty, or c inical) , educational psychology, sociology, and anthropology.

n ering stu ents must have satisfied most basic degree requirements in
t eir own departments or programs, including the completion of qualify-
mg examinations, before entering the community mental health program.
Typically, therefore, entering students have completed two years of grad-
uate training and participate for one full year in the community mental
health program. Clinical psychology students may continue their concen-
tration by taking an internship in a setting with a heavy community men-
tal health orientation. Students from other areas, particularly within psy-
cholog)', have the option of taking a second year in the program. To date,
most of the program's students have entered from the clinical psychology
program.

SPECIFIC TRAINING

ants and approximate!) 10 trainees Consultation is now available to all
of the count) 's schools, and to the general medical practitioners in the
county In addition, a suicide prevention service has been initiated
through the consultation program

Virtual!) from its inception, Duke University’s consultation program
has included graduate students from several departments, interns in psy
cholog), residents in ps) cilia tr>. and colleagues outside of the Psychology
Department Students lnvc been allowed to participate in every phase of
the consulting program and, by entering it before it became a sta 1 ize
operation, many have had the valuable opportunity of participating in the
"initial gropings” of the consultant
The Duke program uses the apprenticeship model Most
dent’s learning is acquired by observing an experience pro e
era ting as a consultant This requires the professional to be quite open
about what he does, and to allou himself to be d “ El ^”tam«s
mg his mistakes as well as his successes clearly nsi e P n but
remain as relatisely passive observers early com[ortable With

gradually participate more actively as they » blem to the train
time, the consultant turns over specific asp being

ee, so that through a senes of graded steps ibetra.neemo con

a relatively un.nvolved nonce to functioning sem.indepinde ^

sultant Heavy program emphasis is place he in turn, has

while the consultant has something to give t e ^° j tee -phis has been

much to learn from the community and from d>econsuh«

found to be a requisite to a successful consu ta _ have been psy

Most of the trainees in .he Halifax Coumyprog^^ m psychol <,
chology graduate students from Duke niv psychiatric residents

gy at the Duke University Medical Center , dua tes taking honors
have participated in the program, some u ‘ ^ program, and var

programs have carried out special projects ^ nursing, soaology,

ious colleagues from psychology, psychiatry, y . wlth the consultants
pediatrics, and public health have participa jnterested in the pro-

m the programs Many of the graduate s duate training by ac

gram begin their involvement very ear y m CO unty One limitation on
companying consultants on their visits to feeling on the part o

the multidisciplinary aspect of this progra ^ to the role carrie ou
its members that clinical training is q ul been res tncted to thir year
m the field Thus advanced tra,ning iiiil _ in psychotherapy
graduate students who have begun ^ al " in f ltt , e P f onnal course ^ork-Sem
The Duke program includes re a iv jn t he psychology an P

nars in community mental health are consultation program

chiatry departments, and staff member* i m the me ntal health

ommend various books and journa rea

FROCRAMS FOR COMMUNITY ROLES / 361

360 / framing for new professional roles

place in a mental health consultation program in the public school sys
tem which is the program s fourth field training setting This consultation
experience is associated with a yearlong seminar in mental health con
sultation During the first three months of the seminar, students are ex
posed to lectures readings and literature reviews of the consultation
process They also observe others engaging in consultation through films
and role play consultation situations Some time is also devoted to study
mg the organization and administration of the school system, and stu
dents attend school board meetings to become familiar with the way im
portant decisions are made Eventually the student is assigned to a school
where he is confronted with many problems associated with the consult
ant s role These include the problem of entering the system, the efforts
on the part of teachers and administrators to inveigle the consultant into
providing direct service to pupils and thereby subverting his role, and the
various ways m which personnel m each school choose to use its consult
ant in keeping with their own insecurities and misunderstandings

Supervision for student consultants is provided by university staff
members and consultants meet as a group for a two- or three hour ses
sion each week to review their activities and to compare experiences To
ward the end of the consultation experience each trainee writes a de
scnption of the school in which he has worked the problems with which
he has had to deal and how he has handled them Principals and teach
ers using the services of the consultants are also asked to submit evalua
tions

The Texas program is too new for a formal assessment of its efforts
Generally reactions of school personnel toward the consultants have
been quite favorable and the reactions of students to their training and
field experiences have been enthusiastic Several students have already
left the university to serve in settings where they can usefully exercise the
skills acquired in the community mental health program

Field Training in Community Psychology at Duke University
The community psychology experience offered at Duke University is
comprised of a field training program that focuses on consultation to
community caregivers in a rural county (Halifax County) in northeast
North Carolina (Altrocchi and Eisdorfer 1970) The program was made
possible when the county health director approached a member of the
Duke University faculty for help in setting up a county mental health
program When the program began m 1959 the consultant visited the
county for a two- to three day period each month to consult with key
community members and with various professionals including educators
welfare workers clergymen and public health nurses Steady program
grow th has resulted in regular consultation visits on the part of 5 consult

CURRENT STATE OF TRAININC IN COMMUNITY PSYCHOLOGY / 563

sociology, nursing, and education Students take time out from specialty
training to apply for a fellowship to support one or two years of work at
the Center . ,

Training in Boston University's program includes course work field
work, and research A r^murement of the progra

work, and research A core requirement oi tne p g* c_nin.fr nn

sequence that includes a practicum in Human Re ations an a
“Theories of Changing' ^ Human J

a modified T group that attempts to provi e Specific

self awareness as well as an understanding of group P
topics covered in this practicum include

sion-exclusion phenomena, communication p P wlth authority

rating, the emergence of leadership ^copmg w ^ fey an
relationships The seminar on Theor ‘ e dlscusslon s S of various change
interdisciplinary faculty and is devot

Strategles available to community psychology lei

Several optional courses are ava ..parch psychological consult

lows These include courses in evaluation j and vano us summer

ation, an advanced practicum in iuman s mtergroup dynamics

residential workshops covering human * , ent p, e ld placements in
and community relations in community liea lth and geriatric facih

the Boston University program tnclu e ' ... j organization, a state
ties the public school system a commun ^ uraining and esalua

commission against discrimination an a zltl0n Little desorption

tion project run by an mneroty vo un geld setting
is offered of the function of the fellow disa dvantages of multidu-

Lip, on and Klein acknosvledgc many ^ problem that within

ciplmary training For the teac , wlde ran ge of preuous P P

a given student group there is apt student, there is consi

non for the material to be offered For .1 e lhe stu den. group

' emotional buffeting as a result of "V iny paruclar issue The
there is a wide range of viewpoints conre # student to find a pw

complexity of this situation makes 1 ro uhidisciphnm ' ra ' g

sonal identity Despt.e these disadvanta^ ^ ^ , one who m
seen to have certain compelling a diiers>(} oI approaches ^

tends to work in the comtnum T (hat characterizes ti ^ < , ncoun

and ways of conceptualizing P r , ir G f wliat will ' cr f 1

gram is also seen to be characters
tered in the community itself

lN comnwmr

CURRENT STATE OF TRAINS’

PSYCHOLOGY „_, m , described might >uf

The wide diversity found in designed them

gest that their organizers g ot o

$62 / training for new professional roles

so that, informally, a background in the literature of the area is acquired.
Some students have been sent for summer training to mental health cen-
ters emphasizing community psychology. Associated with field training, is
a twice-a-month meeting for all who are in the consultation program.
This is an unstructured meeting in which trainees or staff may make
presentations. Discussions are held of crises that may be arising, pro-
grams that are developing, or theoretical or research issues.

The activities engaged in by trainees are virtually identical to the range
participated in by senior consultants. These include serving as group con-
sultants with nurses, ministers, or policemen, consulting in the schools,
and consulting with counselors working at a suicide prevention center.
When he is first assigned to a particular setting, the trainee often per-
forms some direct clinical service, since the agency is likely to press for
this. Typically, of course, such services are directed toward the agency s
most serious and long-standing problems. Each consultant, whether a
staff member or trainee, encounters this type of pressure on entering a
relationship with an agency, and must exert a counter effort to divert his
role from that of a direct service giver to that of a resource for others
who provide direct service.

Altrocchi and Eisdorfer (1970) have reported on their attempts to
evaluate the Duke University training program after approximately 24
students had participated in it. Gratifyingly, virtually all found the train-
ing experience a significant aspect of their professional preparation.
Members of this group anticipated that an average of approximately 35
percent of their time was or would in the future be devoted to community
consultation. This is a higher percentage than the senior consultants de-
vote to such efforts. Other criteria suggesting that the consultation pro-
gram is having a significant impact is the fact that a doctoral dissertation
is in process through this program and another is being planned. Further-
more, five psychology interns and three psychology graduate students
were being trained in the program during the year that Altrocchi and Eis-
dorfer made their report.

Community Psychology Training at Boston University
In 1965 a training program in community psychology was developed
at Boston University under the sponsorship of the Psychology Depart-
ment and the Human Relations Center (Lipton and Klein, 1970) . The
Human Relations Center at Boston University was established to study
human relations within a multidisciplinary context. It is not a degree-
granting division of the university but one to which graduate students
from a variety of departments can apply for one or two years of training.
An essential feature of the community psychology program at Boston
University is that it brings together students from many different fields,
for instance, philosophy, theology, law, business, psychology, social work,

future prospects / 355

training that involve activities bearing some relation to clinical function-
ing. On the other hand, educators, sociologists, anthropologists, and other
social scientists who have participated in multidisciplinary programs a e
been prevented from participating in clinically oriente
though the reasons for these distinctions are obvious, one canno^
wonder if some of the value of the multidisciplinary program is
when members of certain disciplines are kept from participa in
the field training program. Conceivably, some of the gr eat^t :w*k
plinary program benefits might derive bom w ,° 0 ; s con £r 0 nted
nonclinician, well schooled in a relevant ’ Admittedly,

by clinical problems that demand an immediate re P * blU

the supervisory burden in dealing with such tra.nees would be great,
the investment could prove to be worthwhile.

FUTURE PROSPECTS . . ,

. , training in community psychol-
In their summary of the current statu . attempting to predict

on. Snielberner and Iscoe (1970) shy away from out

ogy, Spielberger and Iscoe (1970) shy away They point out
the new directions that community p s ) c 10 0 mu ] t j tu de of new roles for
that within a relatively short period o * im ,i prospects are that these
community psychologists have emerge . w jp be learned about

roles will continue to proliferate. Also a S 1- perhaps this is another
communities and how to function in forms and why to dat ®

reason why training programs have ta <m impose a great deal o

many of the field’s leaders have preferred not

structure. :,y psychology's leaders base

The only type of structure that “j" , t0 training is the rcquu

been comfortable about imposing wt produce generalists. "

ment that community psychology P r community psyc 10 IYr ''

sense, it has been specified by many dot m ^ ^ a reaction to
should not be a specialist. Very 11 e y d emerged for the P 5 > c °°
the rather highly Ypecialized role t Serefor*. been caficd ^

operating within the medical mo e . ' ^ roore flexible, S^ n js

Is a professional who can function in a ^ uC ^ m ^ n the ol her hand^
than the clinic or hospital-bound ? S J C *\ 0 ^iogy progresses.
likely that as the field of community ’ ‘ rog rams.

greater specialization will pristine state it is ,m £^ u bli«hed

true in a variety of other fields. will become jnevit-

diet in what settings community p deVC i op ment becomes Stings

and what forms it will take. Once specifically to par 1 degree

ably training programs will be there is a limit to the

and particular types of functions.

364 / training for new professional roles

keeping in mind the injunction of the Boston Conference participants
against rigidifying training patterns. This, of course, is fanciful. The many
programs reviewed have been developed at different times and in differ-
ent settings. Not having well established examples on which to model
themselves or to react to, the forms taken by the various programs have
probably been a function primarily of available resources, and the talents
and propensities of the particular program organizers.

All of the programs reviewed include some form of field training. In
some cases, didactic offerings, as in the Colorado program, seem para-
mount, with the field training having been added later in the program’s
history. In other cases, the field training is the essential program feature
as, for example, the programs at Yale and Duke universities. In the latter
model, formal course work has a relatively insignificant place and con-
siderable emphasis is placed on the type of field experience offered, su-
pervision of the trainee in the field, and trainee-supervisor relationships.
Programs emphasizing formal course work have relatively little in com-
mon in terms of types of courses offered, judging from titles alone.
Although much is said about the need for acquiring a background in sociol-
ogy. education, anthropology, and other social sciences, relatively few of-
ferings of this kind are present in most training programs Instead, most
course titles sound like broad surveys of the community mental health
field

Considerably more overlap between programs is found with respect to
field training. The professional activity receiving the most frequent em-
phasis by far is consultation. However, consultation practices vary from
program to program. For example, in the Duke program consultants ap-
parently spend some of their time providing direct service to clients,
whereas in the Texas program such direct service-giving is assiduously
avoided. In the City College program consultation has the aim of enhanc-
ing the emotional state of the consultee to improve his functioning with
clients, whereas in other programs such as the one at the Harvard School
of Public Health the consultation process is viewed much more broadly.

Only one of the programs reviewed, the Rochester program, seems to
engage extensively in the creation of new types of service delivery. Con-
sultation may lead to development of new service models in other train-
ing programs, but this receives little training emphasis. In many programs
the beginning experiences in community psychology field training are pas-
sive and observational instead of involving active engagement in consult-
ation, or program development.

In several programs that profess a multidisciplinary emphasis, two
classes of citizenry seem to have been established. One class, with a back-
ground in a clinical area such as clinical psychology, psychiatry, social
work, or nursing has been permitted to participate in phases of field

REFERENCES / 367

Mental Health. In Iscoc. K: C. D. Spielberger (Eds.) , Community psychology:
perspectives in training and research. New York: Appleton-Century-Crofts,
1970. Pp. 163-177.

Caplan, C. An Approach to the Education of Community Menial Health
Specialists. Mental Hygiene, 1959, 43, 268-280.

Caplan, C. Principles of preventive psychiatry. Nets' York: Basic Books, 1964.
Caplan, G. Problems of Training in Mental Health Consultation. In S. E
Coldston (Ed.), Concepts of community psychiatry, a fra f

training Be.ltcsda, Md.t U. S. Department of Hea th. M uctmon, and
Welfare, Public Health Scn icc Publication No. 1319, 1965. p.

Csccn, E. L. Eme T nt Approaches,o^ema!^eal.h Probl Snt n ^ ^

Appleton-Century-Crofts, 1967. Pp. 389-455 Mental H£alth

Cosvcn, E. L. Training Clinical Psychologtsts J to ' ^ Y ^ g. c D ,

Functions: Description of a Practicum p . . training and

Spielbcrgcr, (Eds.). Community psychology:

research. New York: Applcton-Century • Health: A n Analysis of
Golann, S. E. Community Psychology an fc C. D. Spielberger (Eds.),

Strategies and a Survey of Training, n • ’ research. New York:

Community psychology: perspectives tn training

Appleton-Century-Crofts, 1970. Pp. 3 • . Mental Health at the

Iscoc, I. The Graduate Training Program i in <-» (Eds.), community

University of Texas. In I. Isroe, & C tJ. P York: App ]eton-Cen-

psychology: perspectives in training and researc .

lury-Crofts, 1970. Pp. 181-189. Perspectives in training and

Iscoe, I., k Spielberger. C. D. Community P

research. New York: Appleton-Century . Psychology and Their

Levine, M. Some Postulates of Practice in ^ & D . Spielberger (Eds) ■
Implications for Training. In • training and research, ew
Community psychology: perspectives t

Appleton-Century-Crofts, 1970. Pp- 71-M- a Multidiseiplmary

Lipton H„ k Klein, D, Community PsyAMogy ™

Setting. In I. Iscoe, k C. D. Spril**^ App ,e,on.Century.Crofts,

perspectives in training and resear

1970. Pp. 207-214. The Development ot Commu y

Newbrough, J. R„ Rhodes, '^”^7 ^ n^and

Psychology Training at George perspectives in

Spielberger (Eds.), Community W 1970. Pp- 87-98-

research. New York: A ppIeton- n Ins titutional Change.

Reid, R. Mental Health Manpower an ^ j

Psychologist, 1966, 21, 540-549. jn community Ps 7 ch °

Relit. R. The Need for a Body °j f"°" Comm unity 0. Pp. »-»>•

Iscoe. & C. D. Spielberger (Eds.) ■ leto „-Century.Crofts,
training and research. New or

366 / training for new professional roles

of versatility any professional, even a community psychologist, can mani*
fest

It might well be that once specialization sets in, the result will be a
considerably more functional role for the other social sciences in the
training programs For example, in a community psychology training
program preparing people to function within the public school system, it
is likely that many offerings from the area of education will be highly rel-
evant For programs to train workers, for functioning in the inner city,
probably sociology, economics, and political science will have much to
offer to community psychologists With specialization, too, will doubtless
come greater homogeneity in training programs

CONCLUSION

At present, training programs in community psychology reflect the man
date for producing a professional who can be a generalist, someone far
more flexible than the traditional mental health worker. In an effort to
produce such an individual, training programs have taken many forms
and operate through a variety of field settings Although a need for multi-
disciplinary input into these programs is recognized, this aspect of train-
ing has not yet become well established, or taken any clear form Future
prospects are for a continued period of experimentation very likely fol-
lowed by the development of specialization within the field of community
psychology As this occurs, training programs can be expected to take on
greater structure and to reflect more specific input from disciplines out-
side the mental health fields

References

Altrocchi, J, fc Eisdorfer, C Apprentice Collaborator Field Training in
Community Psychology The Halifax County Program In I Iscoe, & C D
Spielberger (Eds ) , Community psychology perspectives in traintng and
research New York Appleton Century Crofts, 1970 Pp 191-205

Bard, M, &. Berkowitz, B Training Police as Specialists in Family Crisis
Intervention A Community Psychology Action Program Community Mental
Health Journal, 1967, 3, 315-317

Bennett, C C , Anderson, L S , Cooper, S , Hassol, L , Klein, D C , & Rosenblum,
G (Eds ) , Community psychology a report of the Boston Conference on the
education of psychologists for community mental health Boston Boston
University Press, 1966

Bloom, B L A Psychology Department Graduate Course Sequence in Community

13 -

the “ nonprofessional hi

community psychology programs

. . „rnfpssional in community psycl

1 m community psychol

Before we discuss the place of the n ® n P^ , This definition 1S

ogy, we must specify what a nonproto^"^ w ho are referred to

obvious when we consider the <h ve *- , ^ /Sobey, 1970) , we

as nonprofessionals Followtng Sobey slead^^ provide mental

nonprofessional as any indlV ‘ ‘‘^pleted customary P rofe ”‘°" he nonp ro-

health services without having P disciplines As su , pro _

m one of the tradmonal mental health ^ a tr a.ned F*"'
fessional may be paid or unpai an roe dicine, or pro .

fessional in some other field (" * o£ th e many

Perhaps one of the most « -f* ^ we define

grams we have reviewed and in by nonpr ofessi fessl0n

tent to which significant ro “ P, hosplta i setting m aJ compan

them Within the traditional m vo lunteer have Zax,

als. in the form of the college student vo 1967 , Klein

ions to hosp.tal.red mental patients (B *»

368 / training for new professional roles

Roen, S R New Requirements in Educating Psychologists for Public Practice
and Applied Research In I Iscoe, fL C D Spielberger (Eds ) , Community
psychology perspectives tn training and research New York Appleton Cen-
tury Crofts, 1970 Pp 59-69

Sarason, S B , Levine, M Graduate Education and the Yale Psycho-Educational
Clinic In I Iscoe, &, C D Spielberger (Eds ) , Community psychology
perspectives in training and research New York* Appleton Century Crofts,
1970 Pp 143-162

Singer, J L & Bard, M The Psychological Foundations of a Community Oriented
Clinical Psychology Training Program Ini Isoe, & C D Spielberger (Eds),
Community psychology perspectives in training and research New York
Appleton Century Crofts, 1970 Pp 125-141

Spielberger, C D , & Iscoe, I The Current Status of Training in Community
Psychology Ini Iscoe, & C D Spielberger (Eds). Community psychology
perspectives in training and research New York Appleton Century Crofts,
1970 Pp 227-246

THE NONPROFESSIONAL IN COMMUNITY PSYCHOLOGY PROGRAMS / S7I

mas 1966) Hawkinshire (1963) has even proposed that a like peer
group be trained to work with criminal offenders
This diversity both m the types of roles being filled by nonprofessionals
as well as in the types of people who are serving as nonprofessionals is
impressive However, the picture that these examples convey may we e
a distorted one, implying as it does that nonprofessionals have tru y ar-
rived and are entirely well established on the mental ea t scene
tually, many of the programs cited stand out drama tica y J ust ec
they are unique structures on an othenvise unremar e on *
subjective impression that programs making use o nonpro es * 1
proliferating u undoubtedly accurate but we lack data to tndic ate ho
these nonprofessionals are for the most part what roles ^generally
filling what permanency their positions tend to enjoy an nonDro fes
Sobey s surrey of .85 NIMH

sionals (Sobey, 1970) . indicates that virtually all of t P Sobey
time in these programs is devoted to direct dcred by professionals
found differences between the types of serv and oup coun

and nonprofessionals Professionals did more in nonpro fessionals

seling and more screening of new patients than ' no P^

Nonprofessionals participated more tn tmonng rofe5Slona l ,n the
group therapy than did professionals Si til th / direct ser vice pro

projects surveyed by Sobey participated V 1S so mewhat at

grams of the agencies that employed them co vered several pro-

odds with that of Grosser (1969) Grosser s ^ Manpow er Devel
grams sponsored by the Labor Department “ . indigenous nonpro-

opment and Training Act which have bas distinguished four

fessionals For the purposes of his survey ^ ' fcssI0n als direct serv
types of service responsibilities assigne ] services provided a

ice to clients services ancillary to the pro et community an

client service involving establishing ties wi , esSJOna i services offere
services that are entirely separate from t « assignments) He f° un
to clients (custodial and certain types ° ^ provide ancillary services
that nonprofessionals are most often use functions transport

Such jobs involve clerical work admims r ser vices Grosser me u
ices and the like Also among these anci ^ thc continuum towa
jobs such as intake work which is fur stl n falls short o »

direct service than the functions mention j east common type ° ^
rect service responsibilities for cl * entS . lS rrosse r asserts that in 0,311
assigned to nonprofessionals althoug sul ted for this ro _

stances the nonprofessionals are pro a ^,-vice is t e ro

for any other In addition to finding . on to provide m j lQ

nonprofessionals are least likely to e hose nonprofession

grams he surveyed Grosser also found that

370 I the "nonprofessional” in community psychology programs

1965; Umbarger, Dalsimer, Morrison, and Breggin, 1962), and even
high school students have served as companions for adolescent and pre-
adolescent hospitalized patients (Fellows and Wolpin, 1969) . The mental
hospital has also been a setting in which new kinds of personnel have
been trained to play a very significant treatment role with patients. The
"socio-environmental therapist” (Sanders, Smith and Weinman, 1967)
and the "nurses” utilized in Jones' (1953) therapeutic community are
examples of college graduates trained specifically for roles in innovative
hospital programs who would ordinarily have no place in the mental
health field.

There are several examples of the use of nonprofessionals in an activi-
ty reserved heretofore for only the most highly skilled professionals. Mar-
garet Rioch (1967) , for example, has trained housewives to do individu-
al psychotherapy. Others (Poser, 1966; Rappaport, Chinsky, and Cowen,
1971) have employed college undergraduates as group therapists in men-
tal hospitals. Carkhuff and Truax (1965a, 1965b) have trained hospital
personnel, primarily attendants, to lead therapy groups. Kreitzer (1969)
has trained college students to participate in a hospital behavior therapy
program for emotionally disturbed children.

In the school setting, Donahue and Nichtern (1965) have recruite^
housewives who are former teachers to act as individual tutors for seri-
ously disturbed children. Harris, Wolf, and Baer (1964) have pro-
grammed teachers to use behavior modification procedures as a means of
increasing desirable behaviors and decreasing undesirable behaviors in
disturbed nursery school children. Casework agencies have also begun to
make use of nonprofessionals to assist in special programs. Johnston
(1967) has reported the use of retired people as "foster grandparents’
for children suffering from emotional disturbances, and Perlmutter and
Durham (1965) have described a program using teenagers as nonprofes-
sionals to supplement casework service with younger children. Youngsters
no older than 10 have been trained to tutor still younger school chil-
dren (Gartner, Kohler and Riessman, 1971). Several programs have in-
volved training parents to do therapy with their own children (Fidler,
Guerney, Andronico, and Guerney, 1969; Andronico, Fidler, Guerney,
and Guerney, 1967; Wahler, Winkel, Peterson, and Morrison, 1965). A
large number of programs, many of which have been described in preced-
ing chapters, have trained nonprofessionals to fill vital roles in a variety
of community mental health programs. Examples include the use of non-
professionals as teacher-aides (Cowen, Izzo, Miles, Telschow, Trost, and
Zax, 1963) , the use of indigenous nonprofessionals to man neighborhood
service centers (Hallowitz and Riessman, 1967) , and to staff a residen-
tial youth center (Goldenberg, 1971) , and the training of nonprofession-
al mental health aides for work in a hospital program in Harlem (Christ-

reasons for using nonprofessionals / 373

als are in drastically short supply, and probably will continue to be for
many years given current training limitations, is to argue for energetic re
cruitment programs to attract talented young people and for a pro 1 era-
tion of professional training programs. Unfortunately, sue an approac
is difficult to implement. Expansion of professional training programs is
extraordinarily difficult to bring about but, even worse, such a solution
promises only to "rob Peter to pay Paul." Should the mental health field
succeed in attracting talented young college stu ents to en er
health professions, it will do so by luring them away from y

other professions that are also in short manpower

cine, education, and the science. Thus the nonprotona become.^
prime candidate for helping to meet the "““P 0 ”" 1Q society ;£ non-
health professions. The greatest benefit wo “ drawn from a segment
professionals for the mental health field cou economy and

of society that normally would not * in-

might even be a drain on society s r« udents> housewiv es with time
dude the retired, the young who are st wfi have a i rea dy dem-

to spare, the delinquent, and the maigen . ^ have drawn lib-

onstrated that many programs utilizing no p
erally from these groups.

To Improve the Life of the Potential Nonprofessional

r iy, r « of nonprofessionals in

This basis for the development of large nu ^ ^ Riessman (1965)
the mental health field was articu ate >r « iessman emphasizedjliat
who termed it the “helper therapy P nnCI P helper as it is ttTtfie helpee.
riving help often is of as muclypro t to . - an i za tions such as Syna-
Benefits resulting from a variety o . — -annul are seen y

Benefits resulting from a variety o se Anonymous are seen y

non, Recovery Incorporated, an c . . Admitting that there was a
Riessman to derive largely from t is P r , t h era py principle, Riessman,
lack of scientific evidence for t e i P functioning in a variety

nontheless, felt that his

dence for the he per ‘ functioning i n a variety c
.is observatton of pe»P of th .s kind w.

aly demonstrated ha a P might acco unt for th

was
the

act u- doing some-

validity of the principle, Riessman P““ self . irnag e, that having to: id\
thing worthwhile tends to tmp rove . nt to the position, t a
cate a position often leads to a “"T^em, and that the she status
ment as a helper gives one a sta e „ e f u l endeavor is 1 men ial
associated with being a helper map d nonprofession a s *

A number of people who have - *'« contention imt

health programs have been able _‘“.^, inE j„ a helping in .

different settings amply demonstrate : j sms that might account

valid. Speculating on the potential m ^ the fact that doing

.... t , . • t „ 'Riessman pointe .t__» Tv'tvino r to

validity of the principle, Ktessi r ]f .; m
ihtn* Mlc lends to improve ones set

s have been aoic - *.* _ Jn a helping *

the helper gains greatly from P 3 ***^ pre hensive studies i.
berg (1967) has done a series o

in this area in-

372 / the “nonprof essional’ in community psychology programs

were providing direct services were more likely to be middle class non
professionals rather than lower class indigenous nonprofessionals
In their roles as agents for establishing bridges between the agency and
the target community, the nonprofessionals surveyed by Grosser serve a
recruitment and a follow up function within the target neighborhood
These functions are accomplished through speaking to local groups, can
vassing door to-door, distributing leaflets, and the like The discrepancy
between the findings of Sobey and Grosser can probably be explained on
the basis of the types of programs that each examined Sobey’s respon
dents undoubtedly represented the most innovative and willingly experi
mental agencies in the country, and it was on such a basis that they re
ceived NIMH funds Grosser’s survey probably covered the more typical
agency, which depends on a variety of sources, local and national, for
support, but which is not in the forefront of change in professional prac
tice The use of the nonprofessional in the latter type agency is apt to be
made grudgingly and, unfortunately, agencies of this kind predominate in
the mental health scene

It is clear that the movement toward the use of nonprofessionals in
mental health programs is well underway It is also abundantly clear that
nonprofessionals who have been pressed into service are extraordinarily
heterogeneous with respect to age, social background, and educational
background, and that the roles they are called on to fill may be quite var
led, although frequently they may be limited to functions that fall short of
providing direct service to clients The rest of this chapter is concerned
with the reasons why the use of nonprofessionals is becoming more prom
ment in recent years, the techniques that are used for selecting and train
mg nonprofessionals and the problems that must be overcome if nonpro-
fessionals are to represent a significant force in the mental health move
ment in the future

REASONS FOR USING NONPROFESSIONALS
To Meet Manpower Needs

The need for a means to bolster the inadequate manpower resources of
mental health professionals is perhaps the most obvious reason for turn
tng to nonprofessionals (Richan, 1967, Grosser, 1969, Harris, Wolf, and
Baer, 1964, Rtoch, 1967) The mental health manpower surveys done by
Albee (1959, 1963) have shaken the complacency of professionals con
cerntng their ability to meet mental health manpower needs within the
framework of current practices

The reflexive response to the recognition that mental health profession

REASONS FOR USING NONPROFESSIONALS / 375

indigenous worker particularly the lower class worker semng the cultur
ally disadvantaged Gordon has stated

A second major advantage of the helping team is that it may include
workers from the same milieu as the clients served by the team an ese
workers could well be much more successful than the fu y qua tfie fro
Icssionat in making contact tt ith potential clients, in motivating cm
in interpreting the agency to the client Where they have been well
trained and well supervised, indigenous leaders have mad implant
contributions which cannot be made by anyone ese . m al

stons of expression, voice inflection, gesture, body ^ m(jl

most instantly recognizable as signs of class an e mc^ g^
genous leader can communicate instantly to t P . , g t es

client, avoiding noblesse oblige m a ^LZZZZoZ yoZ
sionals cannot do when dealing with (lisay > vs tem against

Who see the middle class agency worker as part of the system g

which he is fighting (Gordon, 1965, p 540) ^ ^ ^

Reiff and Riessman (1965) emphasize many ' ^ ^ in digenous

does Gordon They point out that the soci p ^ ^ & r jn terms 0 f
nonprofessional matches that of his client so i n0 nprofessional can
background language and interests As a rest JS not f re e to do

do things that the middle class professiona he can be inV ited to

The nonprofessional can belong to t e ex ^ a p eer 0 f the client
weddings parties funerals— and he is f ree ° lly For t he profession
such flexibility of behavior comes off quite ld doubtless make

al behavior of this kind would be awkward ana
everyone uncomfortable hiving been po° r himself the

Reifl and Riessman also points out i j, n ow how about dea ing
indigenous nonprofessional has deve °P® ^ h is personal experience

with the problems of poverty and can throug^ o£ life sty e

provide concrete meaningful help 11 on oriented less invo

the assistance he offers is more likely to typical middle c ass p

With delay and talk than that characteriz g ^ ^

'“mas (1966) has desert ^

pnved community in which she a t [,e middle c as ,

aides who had lower class roots but are :» * contact w.|h ^ *

phasizes the potent.al benefits to d*** ^ , ype „f 1* that >

who on the one hand -s not far remov* * ^ exafflp le of one '

dten, „ experiencing bu, on the ^.ages As Chr.stmas puts

has been able to surmount his mitia ^ advanced education

The talents and skills which may have come

374 / the "nonprof csstonaV m community psychology programs

vetoing college students acting as kd to gains

disorder, greater tolerance of sexuJ ^ and S? ^ ^ knew a great deal
trospectiveness, and the feeling in treaUnen t than they had before

more about mental illness, its “ us “ a as a result o£ their companion
Followup studies also dem ° n j’ tra JIltcrest in a mental health career

experience some participants declde that suc h a career was

confirmed, whereas others were helpe oarticipation in

not for them Klein and Zax f f" hetd toC up career
a companion program with hospital p. P* health profession

plans for college students, attracting many to e P m Good

and convincing a few that such a career wa . not ^ suited to ^ ^
man (1967) has reported that the college stude ed „ disp l a yed

panions to grade school hoys who were described as . P with

'dramatically heightened interest ' ,n children's behavior, in ^working
the emotionally disturbed and in their own interactions ; wi ^ h f h

in reporting on a program uuhzing retirees ^ memal health m ^

children Cowen, Liebowitz and Liebowitz (1969) had

tirees very much enjoyed their work as aides “ f en.hus.a.
learned many new things at their function and that y San dler

tic about continuing work in such a program Dorr ’ ’ , he pnma ry

(1972) report that housewives working as child aides 1

grades of a public school evidenced greater understanding 1^

non of children's behavior after participating in the program lcipate

one third months than did a set of control subjects who did no P

In many ways the new careers program that was describe P

vious chapter lias its roots in the helper therapy principle . ed

vanced by Pearl and Riessman (1965) is that by giving the ■■»!»”__ w
individual with relatively few hopeful options in life an °PP or rcsu lt
work at something that provides dignity and a sense of purpose ^
in both useful service and important ego enhancement for the se
self The Howard University program (Klein, 1967) which uti u
genous youth, most of whom had serious delinquency records as ^
service aides is a good example of a new careers program intcn ,° ate
prov ide both important new mental health manpower and to re
a segment of society that would normally be a drain on its resources

To Capitalize on the Unique Assets of Nonprofcssionals

Many nonprofessional groups that have been utilized in
service programs possess unique qualities which have ^"^ OUnd [or the
important assets ,n their work This case can be most easily made

SELECTION AND TRAININC OF NONPROFESSIONALS / 377

college student that seemed to create an entirely different and beneficial
atmosphere in the typical mental hospital Some programs (Klein and
Zax, 1965) attempted to capitalize on the college students’ enthusiasm by
having them work with patients who, although seemingly capable of es
tablishing a life for themselves outside the institution, were lacking in mo
tivation to do so Poser (1966) , in attempting to explain why his lay
therapists (college students) seem to have done better with their patients
than professionals therapists, also refers to their ‘naive ent msiasm e
saw their lack of a "professional stance’ as allowing them to engage in
less stereotyped behavior than typifies professionals an as giving iem
considerably more freedom to respond to the patient s particu ar m0 °
the moment Rioch (1966) m commenting on Poser s reS “ J ‘ * *° tu d ent
to the freshness of viewpoint and the flexibility o tie &
nonprofessional She anticipates, however, that this may be a quahty that
wears off in time if the nonprofessional engages in t e sa

3 ^advantage of .he «***«**£

be mentioned is the suggestion by Rio* < osing than profes

to relate to and cooperate with people w , hierarc hy, as they

sionals, and who are closer to the bottom ° a vo i unl eer case aide pro
themselves are Remherz (1964) in descr S uaIlty 0 f the college
gram for school children also commentet w ] 10 j iac j been tin

student nonprofessional She noted that some ’ were able to devel

reachable through traditional therapeutic app ’ y serve as

op meaningful relationships with their case aides,
good identification figures

SELECTION AND TRAINING OF NONPROFESSI

SeleCtion ro fessionaIs have varied

Procedures for recruiting and select: '"S "“"^professionals are used
quite widely, even in different projec s 0 jr t jj e early college stu en
to perform relatively similar functions were interested, or t ose

companion programs utilized self screening for ultimate selec

taking a particular course, and relie o s uch cases the sl “

non (Umbarger et al , 1962, £

came to the hospital for a few session who foun d, after h"« P

to the program It was expected t a bow out grace u I

Sure, that the program was not for the continue In the

who persisted were thought to I be Zax (1965) , potential par

companion program described y

576 / the "nonprofessional" in community psychology programs
and employment may help patients (and other nonprofessionals) to de-
velop their skills. Since most adult urban middle class Negroes are at the
most a generation or two removed from the working class, those who are
relatively free of conflicts around their current status and society may use
this background for greater understanding of the patients'’ (Christmas,
1966 , p. 410).

Grosser (1969) views the indigenous nonprofessional as serving an
important function as a "bridge” between the agency and the deprived
community. His interests are similar to those of the members of the target
community, he talks their language, he lives among them, he shares their
minority group status, and has a similar background. Furthermore, t e
indigenous nonprofessional is often hired because he has succeeded to
some extent in "beating the game,” in mastering problems of living in a
urban slum. Thus he is in a position to teach program participants in a
direct, immediate, and pragmatic way many important skills for coping
with everyday life. He can advise the job trainee about how to deal with
the foreman at work or suggest ways in which the welfare client can ob-
tain larger benefits. The tactics involved may consist, to a certain degree,
of rule bending, but this is seen by Grosser to be no different from the
stretching of rules engaged in by agency administrators for expedience or
economy.

Another advantage of the use of the indigenous nonprofessional m
agencies is that it potentially upgrades the functions of agency profession-
als (Goldberg, 1969; Grosser, 1969) . Some observers have noted that
professionals in agencies employing non professionals feel they are con-
siderably more effective in working with the poor than their counterparts
in agencies that do not employ nonprofessionats. Grosser attempts to ex-
plain this:

" Professional staff has probably been affected more than is generally
acknowledged by the employment of nonprofessionals. For one thing,
they find in the office, on their own side of the desk, as it were, attitudes,
life-styles, and points of view which heretofore they saw only in clients
and usually characterized as pathology. They are forced by their nonpro-
fessional colleagues to justify their practice in client related terms”
(Grosser, 1969, p. 144).

Thus far the emphasis has been on the assets of the indigenous non-
professional. In programs where other types- of nonprofessionals have
been used, particularly college students, other important assets of the
nonprofcssional have become apparent. One significant feature, apparent
in the early college companion programs for mental patients (Umbarger,
Dalsimcr, Mortison, Brcggin, 1962) , was the zest and enthusiasm of the

SELECTION AND TRAINING OF NONPROFESSIONALS / 579

and lay hospital personnel who were volunteers but were otherwise unse
lected for the program Poser (1966) used altogether untrained college
undergraduates who expressed interest in the project but were otherwise
unselected Most of Poser's volunteers had never had course work in psy
chology, and none seemed even to be considering work m the mental
health professions

Similar contrasts in approach have been found among programs train
mg indigenous workers for service in deprived neighborhoods Reissman
(1967), for example, has described a very elaborate procedure for select
ing workers to serve in a neighborhood mental health center Recruit
ment was done through local community agencies, radio stations, the
state employment service, community meetings, and the like The selec
tion procedure involved several steps First, a large meeting was e or
all applicants where the job, the salary, and personnel practices were de
scribed, and where questions concerning the program ivere answere n
the next phase, 10 or II applicants at a time were interviewe as a group
and observed by four judges all professionals (a psyc o ogist, a 5 ° c,a
worker, a psychiatrist, and a nurse) The two peop e con uc ‘"S
terviews attempted to ascertain the attitudes of the can i a es
neighborhood and the people living there, their amtudes jard wel^
discrimination, nunoritVgronps, emotional disturhance t md 1 the l.le A 1
applicants were rated by the judges for empathy, ™

ty. comfort in a group, ability to communicate ideas and '™»

ability and flexibility, capacity for self awareness, r ^ imUa] a p p i, cint
ology, and relevant work and life and another group

group was winnowed down through t P y mdividual interviews
session was held for those who remained Ult ma y ^

were held with any candidates about whom there seem

“ 0n , yirncess the procedure described

By contrast with Riessman’s selection p ’ jdes in( Ijgenous to the
by Klein (1967) for selecting human se cxtr a 0r dinanly simple

neighborhoods in which they were jo D C , were chosen

Recruits for this program, conducted m “j ag< , nclc5 dealing with

from among individuals referred y se ' t j,cse recruits were seen as
problem youth Quite intentionally man t j jcjr p rC uousl> pom* cm
poor risks for the training program cau ^ poor school nehtese

ployment records and histones of c ,n ^ ba5lS f ro m the pool of ap-

ment Selection was done on an almost r ^ !0 , n clude as snde a

ment Selection was done on an almost ru mac j c to include as wide a
plicants that was generated Every e o ^ ru ] e out particular su >•

variety of individuals as possible rath v , JO might or might not sue

groups on the basis of preconceptions

« , arc a lso found in progmmi imohing

Contrasting selection procedu

378 f the "nonprofessional” in community psychology programs

ticipants were interviewed in only a brief screening procedure to rule out
those who seemed grossly unfit for taking part in the program. Similarly,
Cowen, Zax, and Laird (1966) used a gross screening interview to rule
out college students who "seemed either flagrantly maladjusted or grossly
unsuited” to work with primary grade children suffering incipient emo-
tional problems. Goodman (1967) , on the other hand, reported a college
student companion program with "troubled” youngsters in'which a very
careful selection procedure was followed. Applicants responding to cam-
puswide advertisements were required to describe themselves via several
psychological test instruments designed to elicit self-disclosing informa-
tion, and to participate in a group assessment procedure which provided
the major selection datal The group procedure is_striirtnred_f o enco urage
each member to reveal highly personal information .ab out himse lf. On the
basis of this performance in the group, each applicant rates his fellow ap-
plicants, and all are rated by three staff members for warmth, self-disclo-
sure, empathy, rigidity, surgency, and the like. Applicants not viewed as
warm, self-disclosing, and understanding by a majority of all raters, fel-
low applicants and staff included, were rejected.

/ior^ er program to train housewives to become psychotherapists Rioch
( j ) used rather elaborate selection procedures. As previously men-
tionc , ier mental health counselor trainees were recruited from among
musewives recommended by community leaders, women’s associations,
' s. church groups, and college clubs. After turning up an abundance

0 applicants, a complex selection procedure was instituted. Each appli-
:r;i ,fc ° rd autobiography describing both the major facts of

1 an . lcr ow £ view her development. Applicants then were seen
four 'nr°r » ^ staff " iemljer s in groups of eight or ten where they spent
about tfJ nr, 10UrS d i SCU | SSing a variet y of topics and asking questions

discussion asked ITm' aS5igned a P ar,icular r l uc5tion for

In some r ° arTlve at consensus concerning that issue,

en d ing p P ,,ca "‘ s ' vcrc asked to discuss ns a group a tape-re-
‘ £oun f d jut Iistcncd “>• A procedure involved

thf nromm ti °' ^ mernbcrs wo »W feel it they were rejected for
nate more than hair'"!' . 1 ° 8ra P ,1 . y and Sroup sessions svere used to elimi-
vidtnllv hv 11 ' • ° ’. lc a PP 1 icants, and tile remainder svere seen indi-

m'Jl '"T'T" on sc P ara, e occasions. The subjects in
Rioch s project were also administered psychological tests

So that it will not be interpreted ihit i • t i

i,-—..,. ,i. ... r i . cu tl5at R«och s procedures were clabo-

“ * ", c ac,,v,, . y f ° r " V cI > planned to Lin her volunteers in-
™ lp,lb l '" l 'V' ,,,0 “ ld 1 * P°bued out that several programs uti-
linng nonprofess.onals as psychotherapists have used far less elaborate
selection procedures. Carkhuff ami Truax (19651a) , for example, used
student volunteers taking a graduate course in individual psychotherapy

SELECTION AND TRAININC OF NONPROFESSIONALS / 581

for them In the latter case, however, there is much reliance on intuition
and personal predilections since very little empirical data relating non
professional characteristics to performance in specific programs have
been provided

Rappaport, Chinsky, and Cowen (1971) have attempted to relate per
sonahty characteristics of their college student volunteers to their success
as leaders of groups of chronic mental patients They used a variety of
measures including scales rating empathy, nonpossessive warmth an
congruence that were developed by Truax and Carkhuff (1967) , t e
B scale developed for rating therapist characteristics (Betz, 1962), and a
procedure known as the Group Assessment of Interpersona rl * ts
(GAIT) developed by Goodman (1967) Unfortunately none of the
measures of volunteer characteristics predicted reliably to patient c ^nge
More recently Cowen, Dorr, and Pokracki (1972) lave com P^
personal characteristics of women selected to wor as nonp ,

child aides with those rejected for this role They oun “ of

sionals ‘liking’ of the candidate was the most sigm man which

acceptance or rejection These sttidies are ^ models for ,|, e

have not produced important resu ' tS ‘ ^ U y , ve j y lf greater soph.st.ca
type of research that must be carried out extensively b
tion is to be achieved in the selection process

Several who have dealt with the training of m favor 0 f on

ommended that abstract, didactic programs e nnf j R, C ssnnn

the job experiences and learning throng i . n ur tually immc-

(1965) emphasize that on the job * ra,n ‘"^ y fessjona l remains in a tram
diately They feel that the longer the nonp . for *j lic h lie is being
mg phase without actually functioning at aspect of the ness job

prepared, the more anxiety he develops U ’ tas ks to be performed

should be engaged in very early wit 1 1 ie ' handled with little train

phased so that the simplest ones whic 1 ca ^ ^ task complexity

mg, are introduced first As training P r< ^p * n 15 that didactic sev
Another recommendation of Rei '* nc or anting R° ,c

sions should stress doing rather than list g Tcic hmg stvles show d
and role training are much perferrec to ^ have cas> access to 1,11 *
be down to earth and clear, the studen o| „ |s , n training »houh

'idual discussion or supervision am 1101 j 1{ j in t> so that feeling sup*
be encouraged to develop a sense o g 701 P a ncc( j t o imitate pro w ,on
ported by their own group they , R lCS sman believe t iat 1 '

a ls In line with the latter point ei freedom to dcveloph»o* n 1
essential that the nonprofcsstonal have
sonal style of functioning

380 / the "nonprofessional” in community psychology programs

nonprofessionals recruited to work in school mental health programs.
Donahue and Nichtern (1965) recruited a number of “teacher-moms"
without making a general announcement of their program. Their recruits
were acquired “by personal contact." This procedure entailed, apparent-
ly, various members of the school system who were familiar with the proj-
ect recommending women they knew to have had teacher training and
who were thought to be suitable for the program. Although an education-
al administrator and a school psychologist interviewed recruits, the inter-
views were used to discourage those who had any doubts about partici-
pating in the program and to get to know the applicant better rather than
for screening; and no applicants seem to have been rejected as a result of
the interview. Zax and Cowen (1967) described a more elaborate proce-
dure for selecting "teacher-aides” than that used by Donahue and Ni-
chtern. Their recruitment was carried out through local professional
groups and clergymen, both to avoid accumulating too large a number of
applicants and in the hope that professionals would provide a type of
prescreening that would identify a small group of very strong applicants.
Functionally, this effort at prescreening was probably similar to that used
by Donahue and Nichtern. However, in Zax and Cowen’s program, each
applicant was further required to participate in two interviews, one with
t e project directors, and a second one with the school psychologist who
would be one of their direct supervisors. Ratings were made on a variety
o personality characteristics by each interviewer, and ultimate selections
were made on the basis of interview findings. Incidentally, prescreening
and recruitment through recommendation by project professionals or
nonprofessionals is reported by Sobey (1970) to be the most popular
technique in the 185 programs she surveyed.

Few generalizations can be drawn from the foregoing concerning pro-
ce ures or se ecting nonprofessionals. Some criteria are, of course, ob-
Vous. lere an important part of the nonprofessional's function is to
. a5 r in ° na llc anf l Nichtern’s project, it is desirable that the re-
r* l' 1 CaC 1 lcr tra[n ‘ng. Where a program’s target population is a so-

1 class that the traditional professional has difficulty reaching, it is de-
irable that the recruit be indigenous to that class. Programs intending to
capitalize on the enthusiasm and commitment of young people naturally
draw recruits from among college student groups. However, beyond
choices involving these gross criteria, there are few commonly used
guidelines. Some program designers acknowledge openly that they have
little basis on which to establish rigid selection procedures and are comfort-
able to allow volunteers to self-select or to rely solely on a gross screening
procedure for eliminating only the patently maladjusted. Other program
designers begin with preconceptions of qualities that they feel will be de-
sirable in their nonprofessionals and set up elaborate procedures to select

SELECTION AND TRAINING OF NONPROFESSIONALS / 383

Perhaps the most common training model of all that involve nonpro-
fessionals is the one combining didactic training with supervised experi-
ence on the job (Sobcy, 1970) . Tremendous variation is seen, however,
with respect to the nature of the mix between these two training elements.
Rioch (1967) , and Sanders, Smith, and Weinman, for example, have de-
scribed training programs that have been quite long and heavily laden
with didactic materials in addition to job experiences. Carkhuff and
Truax (1965) have utilized a shorter training period to produce psy-
chotherapists for work in a hospital setting. Their program involved ap-
proximately 100 hours of training extending over a period of about lb
weeks. Zax and Cowcn's teacher aides (1967) participated in a -wee
training program that combined didactic sessions with classroom o serva
tion. Hallowitz and Ricssman (1967) trained their neighbor oo servl “
center staff in a prejob period of only 3 weeks before p acing t 1 ”

center for the continuation of their training while on t le jo . J
(1967) trained foster grandparents during a ^id with

before putting them to work, as Fellows and Wolpm (19 9) j"
high school students who served as companions to to p

Perhaps the primary commonalities among the 0 f t h e

actual training programs for nonp^J^“^ ,s ^ e . IlIoIt(!d P by actU aI ex-
notion that abstract, didactic material shoul relatively little com-

perience on the job. Beyond this thc ^ ' e ' mS raining sho uId be provided,
monality with respect to how much form utilize extensive

At times, one wonders if program organizers . u; rities about plac-
training periods to deal with their own ou s < Som€times> as was direct-
ing nonprofessionals in human service settings- rogxa m is intended as
Iy Stated by Zax and Cowen (1967), the tuning progr^ ^ *

much to allay the anxiety of the nonpro essi ^ could bene-
background of information for doing t ie jo . mer its of various non-

fit from research programs designed to assess the merit

professional training approaches. described may be special cases

In some respects the training programs often with the results of

in that they have been reported in the liter. , ^ ^ federally spon-

attempts to evaluate their effectiveness 0 repor i s that training is a

sored programs surveyed by Grosser (1 ) ■ ;j (hat funding age 1 ™ 1 *

neglected feature. One of the reasons to ^ £or prog rams which
tend to prefer that the funds they P rml , nonprofessionals do no
provide visible service. Training progra | x , cn rendered, so t la

eventuate in statistics indicating that sem“* ^ favor of programs that
to maintain a flow of funds, training is neg indicate that

produce quantitative results. Thus man training programs a\ai a

sionals are being trained in cego 1 ^ ^^"“““""ntation period is p«>-
to their total staff. In such agencies n

382 / the nonprof esstonal ' in community psychology programs

Apropos of the latter point, Riessraan (1967) , in a later paper on
training nonprofessionals, points out that nonprofessionals are usually se
lected because they possess characteristics such as informality, humor,
earthiness, and neighborliness On the other hand, they may also possess
many other personal qualities that are less positive for adequate function
mg in the human services field such as punitiveness, suspiciousness, and
moral indignation Thus training programs should attempt to build on
personal traits that will serve well in the kind of work they are expected
to do and should attempt either to control or to train out negative charac
tenstics In the same article, Riessman reiterates the need to provide only
the most minimal degree of training necessary to permit the nonprofes
sional to begin work in a job, and to provide the training for more com
plex functioning while the trainee is actually functioning at his work
Many of the points stressed by Reiff and Riessman are reiterated by
Hawkinshire (1969) He stresses the need for making training clearly
relevant to a job, providing continuing support for the trainee, and setting
up a continuous on the job training program In addition, he stresses the
significance of feedback in the training process By this term he refers
to the necessity for allowing a two way communication channel Here
the trainer provides information in one channel while, m the other, the
trainee has the opportunity to express his anxiety and, with the help of a
supervisor, to adjust his performance to his own expectations
An essential element of many training programs is, in fact, an organ
ized group experience to provide the kind of "feedback’ that Hawkin
s ure stresses Klein (1967) , for example, has described a 4 core group’
which is essential to the training of human service aides in the Howard
University program This core group is defined as

a training group in which its members would learn how society,
small poups people m general , and they themselves felt, functioned, and
developed Within this group aides learn how to analyze personal, social,
and particularly job related problems, make their own decisions, try on
various roes and attitudes for size, and learn to cope more effectively
wit i people and the world around them “ (Klein, 1967, pp 149-150

Similarly, m Goldenberg’s residential center for delinquent youth, a van
ct> of group experiences tint involve a form of sensitivity training are an
essential part of staff training These have been described in a previous
chapter Andromco, Fidler, Guerney, and Guerney (1967) have also de-
scribed a semigroup therapy experience that is fundamental to their
training of parents to conduct filial therapy Parents arc taught to conduct
P a > lI,cn in sessions with their own children within the group but are
also encouraged to use the group to explore their own feelings, so that the
group session involves a combination of both didactic and dynamic elc
ments

PROBLEMS IN THE USE OF NONPROFESSIONALS / 385

health worker’s job is simply too complex to be broken down into ele-
ments that can be handled adequately by untrained nonprofessionals.

Another cause for negative professional reaction is that the introduc-
tion of the nonprofessional into an agency poses a direct challenge to the
status of professionals. Grosser (1969) points out that federal agencies
which support programs involving the use of nonprofessionals frequently
regard the nonprofessional as a change agent who will promote a reor-
ganization of the agency’s service pattern. Agency personnel, on the ot er
hand, prefer to regard the nonprofessional as a facilitator of existing serv-
ices. Thus the inertia that prompts agency professionals to resist attempts
at drastically reorganizing their functions in favor of new, un ami iar
roles, at which they may fail, accounts for many negative reactions
nonprofessionals. It is difficult for a professional who has endured m y
years of training and built up a backlog of experience in a “ rtai " .
role to welcome with open arms nonprofessionals w o are r< ^S
ther to take over their own jobs in part or to promote an rg _
way of functioning within the agency. Manifestations o ’ re _

sistance to nonprofessionals may take many orm *- , to perform

ports that nonprofessionals in many instances are^n f he mid .

direct service functions. Those who are, tend to be . member*
die dass rather than the lower classes. Another pa.
sional to treat middle dass patients and to ass.gn only lower P
to nonprofessionals. nr . narine professionals whose

Reiff and Riessman (1965) recomme P P ref °g y ^fore the pro-
agencies are to utilize nonprofessiona s y fessional 0 f te n is un-
gram begins. These authors believe t ia the r0 ] € that he is to

clear about the capacities of the nonpro essio non p ro f e ssional program
serve. For Reiff and Riessman the success o - ona ] s an d their capacity to
will depend heavily on the flexibility o pro ^ non p ro fessional, and a
understand the aptitudes and potentia ro e advantage of the nonpro-
willingness to reorganize their own jo s o t j iat verbal expressions

fessional's assets. Reiff and Riessman also fested •„ the profession-
of acceptance are not sufficient and must ^ d ations are echoed

al’s actual behavior. Reiff and Riessman Merenda, and Trost

in great measure by Zax, Cowen, . Q f te acher aides into t e

(1966) . These authors describe the mW created in the first year

public school system and reflect on t e P paral ion of teachers to in
of their service because of the ina. equ _

corporate the aides into their functioning. ten dency to overemp asize
Reiff and Riessman also warn f w ‘ hich thereby devalue* d

the potential assets of the nonprofessiona^ ^ a s;milar Grosser

contribution that the professional can ^ professionals to a

(1969) comments on the tendency o

384 / the " nonprofessiondl ” in community psychology programs

vided for the nonprofessional, and he is expected to learn what he can
through staff mettings that are sometimes scheduled regularly and some-
times only sporadically. While feeling uncomfortable with this situation,
many administrators seem to be resigned to living with it. There is a dan-
ger in such a neglect of training in busy agencies which is foreboding for
the entire nonprofessional movement. Should nonprofessionals fail to
learn quickly what they need to know, and fail to receive the backup sup-
port from experienced professionals which may be necessary for perform-
ing their function effectively, they may create more problems than they
help to solve. In that event professionals may use these failures as a rea-
son to abandon the use of nonprofessionals despite their own failure to
have used them properly. The professional’s readiness to banish nonprofes-
sionals from agencies is provoked by a variety of problems that will be dis-
cussed in detail in the next section.

PROBLEMS IN THE USE OF NONPROFESSIONALS

Despite the many potential advantages cited in an earlier part of this
chapter in using nonprofessionals, this movement is clearly not without
its problems and disadvantages. These problems take a variety of forms
ranging from those that derive from the reaction of professionals to the
nonprofessional, through the many personal problems experienced by the
nonprofessionals in working in a mental health field, to the practical
problem of finding jobs and appropriate career opportunities.

The Reactions of Professionals to Nonprofessionals

MacLennan (1969) comments:

" Essentially it has to be recognized that the introduction of the indi-
genous nonprofessional into an agency puts a demand on all to change
not only m terms of the organization of task and job but also through a
need to review values and to reach out to each other so that good com-
munication can be established. In such a situation some conflict is inevi-
table and, it ts only through a willingness to respect each other and to ex-
amine differences that these problems can be satisfactorily resolved”
(MacLennan, 1969, p. 140).

The conflict MacLennan speaks of is doubtless a profound one whether
the nonprofessional is indigenous or not, and probably accounts for a va-
nety of the negative reactions emenating from the professional. Perhaps
the professional's most common negative reaction is concern that the
nonprofessional will not be able to render high-quality service (Goldberg,
1969; Grosser, 1969; Johnston, 1967). Many state that the mental

PROBLEMS IN THE USE OF NONPROFESSIONALS / 587

lie Living under circumstances where it is very difficult to maintain se-
crecy, may make one less inclined to attempt to achieve this. It may also
be that fewer feelings of guilt and shame are engendered by behaviors the
larger society would regard as negative, so that on this account the keep-
ing of confidences seems unnecessary. In any case, the problem of main-
taining confidentiality is one that Reiff and Riessman feel must be ad-
dressed directly in the case of the indigenous worker.

Riessman (1965) in his paper on the helper-therapy principle suggests
that the nonprofessional may be especially prone to project his own per-
sonal problems onto his clients. He recognizes that such projection is a
problem for anyone in mental health work, but professional training pro-
grams ordinarily attempt to grapple with this problem, either inte ectua -
ly or through personal psychotherapy. Since the nonpro essiona o
fails to have extensive training, supervising professionals must be alert
the need to help the nonprofessional avoid projecting ns persona p
lems onto those he is attempting to treat. _ ,

A third problem for many nonprofessionals, pointe ou develop

Riessman (1965) , concerns the sense of defeatism that to d=«lop

in the indigenous worker who approaches h.s nor ™ forthcoming,
thustasm in the expectation that results wil P „ w hen

The nonprofessional’s rest for his work is an asse „ "Vcome
change does not come about as rapidly as he mig • Again _ this is a
overly discouraged and pessimistic about : ^ (he ® enta i health

problem that is common to fledgling prof sora ewhat more impa-

field. The nonprofessional, however, is apt . “ K d by bureaucracy,

dent about this issue, is apt to be more ''“he establishment for being ap-
and is more likely to blame the agency forestall this problem,

athetic and the reason for his lack of success. . be out C on-

Reiff and Riessman recommend that a rea is ic
ceming the expectations of program achievemen ■

ver Struggles with Professionals ^ ^ existed

feiff (1966) has pointed out that just a * .h^'^ntal'health fields, simi-

ong different professional groups wit in professionals and the

struggles can inevitably be expccted ta wecn P. ^ „ the

v nonprofessionals being introduced to t tat the professional

iprofessional is to “serve the function of doing^ ^ estabIishroent
mot do,” he must find a place within ' n,,,, he needs a poner

hout being absorbed by die existing s . power base arises ou

e of his own. Reiff feels that the mt*t * th^the general popnla^

the development of a constituancy, a P ? the nonprofessional can

n that feels the need for the type of serve

386 f the “nonprof esstonal' tn community psychology programs

' somewhat romanticized reaction * to the nonprofessional and thereby to
inflate the virtues of the untrained This is seen by Reiff and Riessman as
reverse alienation and must be guarded against by making it clear that
nonprofessionals are not replacing professionals entirely, their employ
ment merely requires the professional to alter his role to that of consult
ant supervisor, teacher, and coordinator from that of a primary service
giver

The Nonprofessional Must Abandon an Established Life-Style

As MacLennan (1969) points out often the nonprofessional must
change his life style dramatically when he becomes a mental health work
er Simply the fact of having a steady job, and not * hanging around” in
the old neighborhood with the old group makes him a different kind of
person A regular income makes it unnecessary for him to perform delin
quent acts his contact with well-educated people opens up new vistas for
him, and his view of himself undergoes a change This change inevitably
involves a certain degree of conflict for most indigenous nonprofessionals,
and some are unable to persist in the face of it

Another danger is that those who manage to persist and -accept the
c ange m their outlook and way of life, may begin to feel contemptuous
trnvar the type of people with whom they grew up and whom they are
now expected to serve Goldberg (1969) points out that many nonpro-
essionals are criticized as not being empathic and understanding toward
their own social class Instead, they may look down on those who have
managed less well than they themselves Reiff and Riessman (1965)
speak of this as "ovendentifymg with the agency ” They suggest that this
pro em is i ely to be a continuing one for nonprofessionals, and one
» * t0 monilored carefully by agency professionals The dis

* 1C n ° n P r °k SSIOna l an d his impoverished client is likely to
longer the nonprofessional works m the agency Dealing with

L , C | 15 ' lc,lltated when the agency's attitude toward its under
privileged clients is genuinely positive

The Nonprofcssional’s Newness to the Mental Health Role

Several problems have been identified by different observers that de
me partly from the nonprofessionals newness to the mental health role
These problems also affect the flcdghng professional, however, they may
be more intense in the case of the nonprofessional One problem con
C / C l 1 *™ llC ,ssue of maintaining confidentiality Reiff and Riessman
(I9G5) point out tint the indigenous nonprofessional who has grown up
m a densely populated area where privacy is a rare commodity may be
insensitive to the need of keeping a client's problems from becoming pub-

CONCLUSION / 589

are, of course, the largest dispensers of human services they tend to be
chronically understaffed, and they serve the poor, the very clientele with
whom many new careerists are thought to be particularly effective Un
fortunately, many of these agencies are organized along bureaucratic
lines, with entry jobs and career lines clearly laid out in a way that makes
the introduction of a very new type of worker, and particularly one w o
tends to be relatively poorly trained in the formal sense difficult There
may also be considerable resistance within agencies to the restructuring
of tables of organization m order to make room for nonpro essiona s o
some extent, existing supervisors may be threatened y t e possi 1 1
that their own status or prestige will be diminishe 1 new en *7
staff are less poorly qualified and lower paid than was t e case
Administrators, too, may be threatened by the possi 1 ity ia
duct, on of personnel with relatively poor formal preparation will lower

the morale of existing staff r n96 7) points

This state of affairs makes it imperative , f unctl0 n m a spe

out, the nonprofessional be trained to perform a u gencies contacted
cific setting, with administrators of potentia recipi encouraged to hire
at the very beginning of the training P r0 EF a n wlth pote ntial em
trainees Trainers must maintain a contin g h resolution of

ployers of the nonprofessional and must ‘^ropna.e em

any practical problems that threaten to completed

ployment for the nonprofessional once his traini g

CONCLUSION . . „„„ he

i rhe mental health scene is be
The introduction of the nonprofessiona t j ie f act that it helps re

coming prevalent Many good reasons , eroent it is a movement

solve manpower problems support t is Some of them are con

however, that is fraught with many P r ° [D lram people who are to

cerned with the issue of how to select an atlv ely little systematic re

be employed for mental health funcll °" an d most programs have

search has been done to solve these pr Qther problems inherent in

dealt with these issues arbitrarily * ' n '^ , , j ( ; are probably not so u

using nonprofessionals in the menta e They involve the nega w

on the basis of research and systematic study ^ Bonal problems that
reactions of professionals to nonprofessional^^ P^ , health fidd

the nonprofessional is apt to bring 0 w , t hin agencies talcing «
the power issues that will inevita y j problems of reorga

groups of nonprofessionals and the P " ‘ /reduction of a .nonprofit,

ex, sung bureaucratic structures to pe™ n*e i Many of these latter prob-
Slonal who can find a career within an g

388 / the ‘nonprofessional in community psychology programs

provide As a direct service giver to the poor, the nonprofessional is often

m an excellent position to develop such a constituancy

Grosser’s survey of federally sponsored programs utilizing nonprofes
sionals (Grosser, 1969) indicates that, as Reiff asserts, nonprofessional
staff do create serious tensions within agencies They are viewed as being
demanding concerning job placements and as tenacious concerning job
development Furthermore they are often not content to operate within
the boundaries of assigned tasks and are seen as wanting to "take over
the entire agency ”

The pressure exerted on agencies by federal fund granting programs to
employ nonprofessionals is also seen to have forced many agencies to
embark on such programs without really wholeheartedly favoring them
Many agencies seem particularly resentful of having to hire indigenous
nonprofessionals One agency administrator expressed the feeling that his
project was ' paying the price for a hundred years of discrimination by
the entire community Another complaint centering on power issues has
to do with the feeling among professionals that, even in cases where a
nonprofessional is essential to a successful treatment program, the agen
cies are seriously limited in how freely they can reassign or dismiss indi
genous workers because of the threat of reprisal from the nonprofession
al's constituancy within the local community

The power issues described present a serious problem that must be
reckoned with in any program making extensive use of nonprofessionals
Essentially the nonprofessionals represent a new force within the mental
health movement, which to be effective in its mental health role, must
maintain its own identity and integrity Failure to do so may easily lead to
a dilution of that aspect of the force that is new to the mental health
scene and that probably is its most potent element Clearly, however, the
establishment of such a force must create tension with forces already pres-
ent within the mental health establishment These tensions threaten to
dncrt botli professionals and nonprofessionals from what should be their
primary goal, the provision of optimal service to those needing it Only
time and experience can lead to a good resolution of these conflicts Rec
ogmzmg the potential for their existence and anticipating them, however,
should aid in an eventual resolution

Finding Appropriate Jobs

Ultimately, the success of the nonprofessional movement will depend
on the availabilit) of positions for this type of mental health worker
Goldberg (1969) points out that many observers feel that the majority of
nonprofessionals, who are essentially new careerists, should be employed
in public health, educational, or welfare agencies Agencies of this kind

REFERENCES / 591

Fellows, L , k Wolpin, M High school psychology trainees in a mental hospital
In B G Guerney, Jr (Ed), Psychotherapeutic agents new roles for
nonprofessionals, parents, and teachers New York Holt, Rinehart 8.
Winston, 1969 Pp 274-277

Fidler, J W, Guerney, B G, Jr, Andromco. M P, & Guerney, L F Filial
therapy as a logical extension of current trends in psychotherapy In B G
Guerney, Jr (Ed ) , Psychotherapeutic Agents New roles for non profession
als, parents, and teachers New York Holt, Rinehart & Winston, 1969 Pp
47-55

Gartner, A , Kohler, M , & Riessman, F Children teach children New York

Harper & Row, 1971

Goldberg, G S Nonprofessional in human services In C Grosser W E Henry,

J G Kelly (Eds ) , Nonprofessionals in the human services San ranos

Jossey-Bass. 1969 Pp 12-39

Goldenberg, I Build me a mountain Cambridge Mass The MI r
Goodman, G An experiment with companionship therapy college st “ ,

troubled boys assumptions, selects, and design American Journal of
Public Health, 1967, 57, 1772-1777

Gordon, J E Project cause the federal anti ychOtopst, 1965, 30,
implications of subprofessional training A

334-343 Prosser, W E Henry, & J G

Grosser, C Manpower development programs l San Francisco

Kelly (Eds), Nonprofessionals in the human services

Jossey Bass, 1969 , nonprofesstonal m a

"■'■“7 V

F The role of the ^

community mental health neighborhood service center program
Journal of Orthopsychiatry, 1967, 37, 766- rei nforcement on

Hams. F R , Wolf. M M , & Baer, D M Effect of adult social

child behavior Young Children, 1964, 20. ^ working in community

Hawkinshire, F B W Training procedures for o p„ e l, 0 therapeutic agents
treatment programs In B G Guerney, Jr t t , ac hcrs New York Holt,
new roles for non professionals, paren s,

Rinehart 8: Winston, 1969 students as companions lo

Holrberg, J D, Knapp, R H , is Turner. J E M Zax (Eds ), Emergent

the mentally ill In E L Cowen, E A Gar • App Ieion Century

Approaches lo Mental Health Problems New

Crofts, 1967 Pp 91-109 _,„dpatems for emotionally

Johnston, R Some casework aspects of u»”S _ “

disturbed children Children, 1967, , Treatment Method in Psychology

Jones, M The Therapeutic Community Neur re

New York Basic Books, 1953 in E L. Cowen, E. A Gardner,

Klein, w L The training of human service aides , H „ llh Problems New

& M Zax (Eds), Emergent Approaches to
York Appleton Century Crofts, I

390 / the "nonprofessional ’ in community psychology programs

lems will require considerable time and experience before they are
resolved The best that can be done at present is to anticipate what prob
lems threaten to occur in a given program and to take steps to forestall or
alleviate them once they arise /

References

Albee, G W Mental Health Manpower Trends New York Basic Books, 1959
Albee, G W American psychology in the sixties American Psychologist, 1963, 18,
90-95

Andronico, M P , Fidler, J , Guemey, B G Jr , 8: Guemey, L F The combina
tion of didactic and dynamic elements in filial therapy International Journal
of Group Psychotherapy, 1967, 17, 10-17

Betz, B J Experiences in research in psychotherapy with schizophrenic patients
In II H Strupp &. L Luborsky (Eds ) , Research in Psychotherapy, Vol 2 ,
Washington, D C American Psychological Association, 1962 Pp 41-60
Cirkhuff, R R , Tmax C B Lay mental health counseling~Tlie-effe«s of lay
group counseling Journal of Consulting Psychology, 1965 29, 426-451 (a)
Cirkhuff R R &. Tmax, C B Training in counseling and psychotherapy An
c\a nation o an integrated didactic and experiential approach Journal of
Consulting Psychology, 1965, 29, 333-336 (b)

Christmas J J Group methods in training and practice Nonprofessional mental
ealth personnel in a deprived community American Journal of Ortho
psychiatry, 1966, 36, 410-419

^ ^ orr ' D A , R. Pockraki, F Selection of nonprofessional child aides
8 220-226 merml heaUh PrOJCCt Communit y Mental Health Journal, 1972,

C °' V nrrw'nf"' ’ ^ L H ’ Telschow * E F • Trost. M A , & Zax, M A

p » ,VC mcnt1 program in the school setting Description and

Evaluation Journal of Psychology, 1963, 55, 307-356

k ^ Leibowitz, G The utilization of retired people as
1908. 95. 900-909 ” ‘ " !d '°° h Amer,can Journal oj Orthopsychiatry,

, ^ J D A college student solunteer program in the

5i™j28 ar ’ ! "" nB C ° mmun “> Health Journal, 1906. 2,

D ° n p' U '' & N,d ' ,crn ’ S Teaching the troubled child New York Free

Press, 1965

Don. D . Cosscn, l. L , S. Srndler. I Changes in nonprofessional mental health
workers response preference and attttudes as a function of experience
Unpublished manuscript University of Rochester, 1972

REFERENCES / 393

Umbarger, C C , Dalsimer, J S , Morrison, A P , Breggin, P R College
students in a mental hospital New York Grune and Stratton, 1962

Wahler, R G , Wmkel, G H , Peterson, R F , & Momson, D C Mothers as
behavior therapists for their own children Behavior Research and Therapy ,
1965,3,113-124

Zax, M, & Cowen, E L Early Identification and Prevention of Emotional
Disturbance m a Public School In E L Cowen, E A Gardner, & M Zax
(Eds ) , Emergent approaches to mental health problems New York
Appleton Century Crofts, 1967

Zax, M , Cowen, E L , Izzo, L D , Madoma, A J , Merenda, J , 8: Trost, M A A
teacher aide program for preventing emotional disturbance in the schoo
setting Mental Hygiene, 1966,50,406-415

392 / the “nonprofessional” in community psychology programs

Klein, W L , a. Zax, M The use of a hospital volunteer program m the teaching
of abnormal psychology Journal of Social Psychology, 1965, 65, 155-165
Kreitzer, S F College students in a behavior therapy program with hospitalized
emotionally disturbed children In B G Guemey, Jr (Ed ) , Psychotherapeu
tic agents new roles for non professionals, parents, and teachers New York
Holt, Rinehart & Winston, 1969

MacLennan, B W Special problems in training the nonprofessional In B G
Guemey, Jr (Ed), Psychotherapeutic agents new roles for non profession -
als, parents, and teachers New York Holt, Rinehart 8. Winston, Inc , 1969
Pearl, A , & Riessman, F Poverty and new careers for professionals New York
Free Press, 1965

Perlmutter, F , & Durham, D Using teenagers to supplement casework service
Social Work, 1965, 10, 41-46

Poser, E G The effects of therapists’ training on group therapeutic outcome
Journal of Consulting Psychology, 1966, 30, 283-289
Rappaport, J , Chinsky, J M , & Cowen, E L Innovations in helping chronic
patients New York Academic Press, 1971
Reiff, R Mental health manpower and institutional change American
Psychologist, 1966, 21, 540-548

Reiff, R , 8. Riessman F The indigenous nonprofessional A strategy of change
in community action and community mental health programs Community
Mental Health Journal, 1965, Monograph No 1, 3-32
Reinherz, H The therapeutic use of student volunteers Children, 1964, 2,
137-142

Richan, W C A theoretical scheme for determining roles of professionals and
nonprofessional personnel In B G Guemey, Jr (Ed ) , Psychotherapeutic
agents new roles for non professionals, parents, and teachers New York
Holt, Rinehart 8. Winston, 1969

Riessman, F The * Helper Therapy” principle Social Work, 1965, 10, 27-32
Riessman F A neighborhood based mental health approach In E. L Cowen,
E A Gardner, R. M Zax (Eds), Emergent approaches to mental health
problems New York Appleton Century Crofts, 1967
Rioch M J Changing concepts in the training of psychotherapists Journal of
Consulting Psychology, 1966, 30, 290-292

Rioch, M J Pilot projects in training mental health counselors In E L Cowen,
E A Gardner, 8. M Zax (Eds), Emergent approaches to mental health
problems New York Appleton Century Crofts, 1967
Sanders R Smith, R, &. Weinman, B Chronic psychoses and recovery an
experiment in socio-environmental therapy San Francisco Jossey Bass, 1967
Sobey, F The nonprofessional revolution in mental health Columbia University
Press New York, 1970

Tmax, GBR. Carkhuff, R R Touard effective counseling and psychotherapy
training and practice Chicago Aldine, 1967

THE ROLE OF THE COMMUNITY AND COMMUNITY PSYCHOLOGY / 595

agency with the typical business firm as a means of understanding this
problem The essential force tint prompts the business firm to be respon
sue to consumer demands is competition In a market where people have
many alternatives, they have the freedom to sample and to settle on what
product suits them best This forces the business, as Bredemeier puts it,
to "heads up playing” The product must be altered and shaped to suit

the demands and needs of potential consumers

By contrast, in the social agency field, competition does not exist
Agencies are thoroughly professionalized, are very bureaucratic, an e
competition among them is mainly for philanthropic dollars In its ro e as
a service prov ider, the agency is less dependent on its clients t an it is on
its employees Agencies have a monopoly on services t at are in s or
supply, so there is no dearth of clients Professional manpower s or ag .
make the acquisition and maintenance of sufficient sta muc 1 m
cult than the problem of attracting clientele Therefore
are often protected by the agency structure when they a.l to be consider
ate of clients The businessman or entertainer canno imme diately

sitive to the rushes of his consumers because he su ers regularly

and materially The personnel of a social agency, .

sheltered from the effects of their own indifference agencies hare

Taking Ins analysts further, Bredemeter J a t he calls

avoided dealing ruth certain social classes ^ S c0StIy m
"handicapped potential" One reason is ‘ ^ J (he han dicapped
terms of time and money to derelop the p ma y be nece ssary

than it is to develop those of more pr'Jtl'g envjronment 0 f the handi
to establish more elaborate control over irc t he effort of anctl

capped to deal with them effectively It may 4 4 j wor kers to

lary professionals such as remedial rea in ^ an( j tbe l,ke Costs of
visit in the homes special classes in t e sc Another, perhaps more
this kind cannot be met by the ordinary age y ^ dmanly used b y agency
crucial cost is the obsolescence of the me ned t0 deal with a very

personnel The typical professional has e ed by the lower class

different kind of material than that w ic i fonce ptualizing problems in
es The professional who is predispose ce a client who knows

terms of the Oedipal conflict is hard pu rtjnen t depends on her

that his mother’s income from the we

producing more children ” cmation that obtained under tt

In the light of this description of the for t he emerging com

old order, it is not surprising that a , hoTbest to create new agen

t^unity movement has been the ques i tQ lts clienteles nee s

cies that are both sensitive and encouraging commumty in

answer to this question has been o ^ ^ tbe agencies that a
volvement and even community contro

14 .

the role of the community
and community psychology

Dncholan^n! C . hapters oI tlus bool; <he P 01 nt was made that community
ns Ts , V i?'" IarEdy h*™* m»tal health pro-

d na manv n " ,radltl °" aI1 >' p™‘>«d, have had little to offer in
apparcnTZX 5 ° C ‘ P ,™ b1 ' OTS F ^>hermore, it has become very

LueTute need of mCma ' ' ,eaUh P™ 6 *™™ have had to offer best
tiirust [ tl d m privileged social classes Hence, while one

S has imohcd - a “^p“» ^p—

neet ,o Tie , ° na ra ™' al l,eaIth Ktli ngs, mother lias reflected a
«mce rrflmTT '° S ° C ' a ‘ das5cs Piously ignored and to make
classes ° '* <ypCS ° prohlems experienced by tliese social

rialU a h™ 0 l 0Ca,he , ***? l" " hiCh 1,C dOC5 a market analysis o[ the so-
diern „ nd ' Cap P Cd ""c, ' h ?, aSCnCicS ,ha ‘ ">ust presumably deal with
basT ’ll T C -' er , ( ) ™ SS<:S 50me of ‘hr reasons why agencies

base been relat.sel) unrespons.se to client needs He contrasts the social

3M

SOME PROBLEMS WITH THE CONCEPT OF COMMUNITY CONTROL / 397

often promised much only to produce disappointing results In the rest of
this chapter we consider some of the problems of implementing commu
nit> involvement in and community control of mental health agencies and
discuss specific examples of efforts to surmount these problems

SOME PROBLEMS 'WITH THE CONCEPT OF
COMMUNITY CONTROL

Although the notion of encouraging greater community inv o v emen
the operation of mental health agencies would seem to a °°\ .
proach to correcting the insensitivity and neglect mam este
agencies over the years, it takes little reflection to recognize t ^ ^

many problems in implementing that approach (see igure ;

Built on a former garbage dump that thrusts mto 0 stark,

lumbia Point Housing Project has never been an a PP e ° ’ veriS j, e d Blacks
institutional style buildings and their occupants— now , s0 Iated both geo-

°nd Puerto Ricans, with a majority of white pensioners priva te doctors in

graphically and culturally from Boston proper ere a ^
the project, and Boston Gty Hospital is a on 9 us Columbia Point Health
The projects one bright spot since 1965 as W(th federal funds the

Center, organized by Tufts Umvers ty Med ca an j social services After

center has provided a variety of high quality me ‘ j thaf 91 % 0 f the people
the clinic's first two years of operation a survey s , oc d ' or 'very good
thought that the medical care available to em _ altogether Reason
Now the 1,130 families are in danger of Ios,ng |n the cen ter and black
chronic and bitter controversy between pro essi kind of f>9 ht ,hat 0CCUrS

community activists in an unstable environ

all too frequently in and around ghettos medicine, wh ch crig na /

Tufts has abolished its department of P re ’ M elsewhere for ca
sponsored the center, and has encourage P Q j workers have quit 0

Four of the chmcs's seven doctors and all of it ^ have sfopp ed the oth
fear and frustration Though last minute negt for sm vivol are

profess onal staffers from following the cen j css oult-ah*' a y 5 0 p j
For, 0, the reason ,s crime Fear a, robbrny ne r apartment ^

—has worsened to the point that many ■ j n the pa st caUp , .

ten remo n empty because of the pro.ecfs repu*™ ^ and doctors al he fc*
the threat of crime has become so senou

396 / the role of the community and community psychology

created Many reports are beginning to appear describing efforts to en
courage community involvement and to incorporate residents of local
communities on agency boards (Salber, 1970, Tischler, 1971, Whitaker,
1970) Clearly, creators of new agencies are in many respects becoming
much more sensitized to the demand that their services be “relevant” to
their clientele and are struggling to create a structure that will respond
promptly to local needs

Smith and Hobbs (1966) , in setting forth guidelines for the new feder
ally established comprehensive community mental health centers, assert,
almost at the outset of their discussion, that “For the Comprehensive
Community Mental Health Center to become an effective agency of the
community, community control of center policy is essential” (Smith and
Hobbs 1966, p 500) Their reasons for this recommendation go beyond
the issues discussed heretofore They point out that under our traditional
mental health system the mental patient ’ was abandoned by his com
mumty His mental disturbance was seen to be his own "private misery ”
One of the essential purposes of the new community movement is to af
firm that serious emotional disorder stems from the “breakdown of nor
mal sources of social support and understanding, especially the family’
Thus, when a person becomes emotionally disturbed, it is not simply one
individual who has gone wrong His disturbance can be viewed as a
symptom of a fault in the entire social system in which he is embedded
Therefore, the role of a treatment agency must include work with various
components of the patient’s social system to help it function in ways that
will better sustain him This requires a partnership between the mental
health center and the community The mental health center must be
come integrated into the life and the various institutions of the communi
ty it serves In a sense, therefore. Smith and Hobbs’ plea for more com
mumty involvement, and even control over mental health centers, is as
much for the purpose of making the community more sensitive to its re
sponsibihty in the breakdown and rehabilitation of the emotionally dis
turbed as it is to sharpen the agency's sensitivities to the community's
needs

From the foregoing, it would seem that the argument for the communi
ty s playing an increasingly central role in the functioning of the mental
health agencies is quite compelling It is difficult to deny that traditional
agencies have failed certain social classes badly The insensitivity of the
community to many serious disturbances is also easily documented The
seemingly obvious solution to these problems is to have the community
run its own service agencies This would seem to ensure that the com
mumty will have what it needs and wants and will become far better
aware of its own role in the development of behavioral disorder But will
such a solution work? Simple solutions to complex social problems have

besieged Says Dr Sol Fleishman, a former medical director "When I first came
I didn't hesitate to go out on calts even at night By last year 1 thought twice
before going out in broad daylight "

Even more damaging has been the political warfare, with Tuffs and the
medical staff on one side and militant critics from the community, most of them
black, on the other A loosely knit elected body called the Columbia Point
Health Association often speaks for the clinic's opposition, though some attacks
have come in the form of anonymous leaflets charging incompetence and in
sensitivity The controversy reached a crisis point last spring after the then
administrator Leon Bennet Alder, a frosty Englishman who had little rapport
with the neighborhood, tried to cut costs and personnel he considered super
fluous He also attempted to fire a black business manager whom he accused of
gross incompetence Bennet Alder became the target of threats by phone and
leaflet Then, on the way to work one morning, he was bludgeoned so viciously
that his skull was shattered There was no attempt to rob him, and the identity
of the assailant remains unknown Bennet Alder recovered and left the center
the business manager still has his job

Angry Wolves One of the gut issues continues to be white collar jobs for
project residents Dr Jack Geiger, the center's creator, points out that pumping
large amounts of cash— the current budget is $1 4 million— into a desperately
poor area is risky "Its like throwing a pound of meat to 50 angry wolves" he
says "They'll kill each other to get a bite " But racial pride and sensitivity about
the condescending attitudes of some white professionals are also crucial factors
Gloria Nelms, a black former psychiatric counselor at Columbia Point who is
among those responsible for the leaflet attacks, charges that ' Bennet Alder did
everything possible to keep the Health Association from developing the ability
to run the center He also cut off training for paraprofessionals from the com
munity" Opposition from some quarters in the community is virulent Even some
of the newer black administrators are being pilloried for 'the same plantation
mentality as the whites who came before "

Help has now arrived with the intervention of Action for Boston Community
Development (ABCD), a city wide agency that has replaced Tufts as the ad
ministrator of federal funds for the center The group is heavily staffed with
blacks and Is determined to rally Columbia Point residents in support of the
clinic ABCD is trying to enforce some of the efficiency measures started by
Bennet Alder but is imposing them gradually It has also hired a black as acting
administrator and persuaded the remaining staffers to stay for a while The
agency, says ABCD Director Bob Coard ' is not about to retreat from involve-
ment in Columbia Point because of a few faceless saboteurs" Coard may
succeed, but for doctors like Fleishman, the retreat is final ' 1 got battle fatigue,"
says the physician, "after 61 years of hassles with everyone "

Figure 1 A Health Centers Problem vuth Community Involvement (Time, October
50 1972 p 71)

SOME PROBLEMS WITH THE CONCEPT OP COMMUNITY CONTROL / 899

ample before one can speak of community control it is necessary that a
definition of the community, or some way of identifying the community
be settled on Just vvlnt is the community of which we are speaking?
Next, even if we define the community to our satisfaction we face the
question of where to find it Does a particular geographical locale encom
pass the community? If so do its boundaries conform closely to those o
an area of responsibility of a particular agency? Going further even 1 t e
community, elusive entity tint it is is identified and located how are its
representatives to be selected? Who speaks for the community? Finally
even if seemingly satisfactory representatives are selecte to spea
community, are they knowledgeable enough about the unction o
health agencies to play a meaningful part m their managemen
these are broad issues that must be dealt with to lieve P the
about the role that community members might e a e o p
functioning of mental health agencies

Defining the Community

io matter because of the varied
Defining the community is no simp Greer (1955) has

ways in which human groups org * . organl2at ion as his style
traced the increasing complexity of man tended to live in

of life has changed He points out that primi > over circum scribed
small groups sustained through htmung ; an h ^ t h e ir entire social
areas Individual members depended on men b r sta(us dl ff e rentiations
existence They lived in close physical proxin ^ KX and they m
between them were based almost exclusive y 0 tensc ]y For groups of this
teracted with each other constantly and very 1 Ie one The group

sort the definition of the community is a relatively P
one lives in is his community irv for humans to group

The invention of agriculture led to a complex social system

themselves into villages involving a muc 1 ^ tende ncy toward deve

that was characterized by divisions o a °y agricultural pro ucts

opment of specialized roles As soon as a ^ vea i t h of members of the vi
was created variations came about in 11 , jn one particular oca

lage social group The tendency to live o cularly extended family

led to a wide integration of many gr° l 'P however the village co
groups Despite its increased social co P > behavl0r 0 f ns n® 1 *" ,

tinued to exercise powerful control ov ^ aggregate of mdivi

remained a social group of a sort rat er . dua i members depen e
This was because within .he village ot rhe surplu pmd

each other for status access to P roduct ’°” nty In many respecu the
U«s of the group and social and l* r «" ts ^habitants depended on
village remmned a self sufficient entity Thlls human groups
the world that it provided for most o

400 / the role of the community and community psychology
organized along village lines, the problem o£ defining the community is
still a relatively simple one. As Greer points out, the village, as a territo-
rially defined entity having truly functional meaning for all its members,
is very much a community. To be sure the village community does not
order all of the behavior of its members in the same sense that the more
primitive social group does, since other structures within the village, such
as the extended family, differing age groups, or conjugal families, inevit-
ably modify the village community’s controlling power. Still, community
controls are strong and result in behavior which is sufficiently uniform
that the cultural anthropologist can justifiably study a few village mem-
bers and feel secure that they well represent the relatively homogeneous
world of village behavior.

Most societies, however, have gone beyond village communities.
Heavy concentrations of people have grouped themselves into spaces so
small that they cannot produce all of their own necessities; such concen-
trations characterize the city. The city sustains itself by exporting goods
or services such as its manufactured products, military power, adminis-
trative order, financial credit, and the like and must import necessities
like food and raw materials. Thus existence of cities becomes possible
only after a number of agricultural villages are established that can pro-
duce enough of a surplus to maintain an urban population. An important
characteristic of the city is a spectacular increase in occupational differ-
entiation. In the cities, the professions, such as the clergy, the military,
the government workers, the merchants, and the like develop. Even the
ordinary population is absorbed in a variety of specialized work' that is
related to trade and industry. In addition to this occupational differentia-
tion, the city is characterized by much physical and, to some extent, so-
cial mobility. People move around within the city far more than villagers
do fromone village to another. One effect of urban mobility is to insulate
the individual socially, since a change in locale often allows him to escape
from local “public opinion." Tofller (1970), in his book on “Future
Shock," documents the increasing superficiality of interpersonal relation-
ships resulting from technological advances that make movement over
great distances very easy.

These complexities of urban society seriously complicate the problem
of identifying or defining communities. The urban dweller is typically de-
pendent on many different social groups for the fulfillment of different
needs. He may depend on one group for his income, another for his rec-
reation, a third for his religious needs, and so forth. Even his family,
which in other societies is often depended on for a variety of these func-
tions. may l>e relatively unimportant to him. Furthermore, the geographi-
cal bounds within which an urban dweller has most of his needs met be-
come greatly broadened. lie may live 15 to 20 miles from where he

SOME PROBLEMS WITH THE CONCEPT OF COMMUNITY CONTROL / 401

works, and may depend most heavily for his recreational gratifications on
settings that are likewise far from the neighborhood in which he resides.
This weakens the functional importance of his immediate neighbors an
results in a decline of the urban neighborhood. In the big city a persons
true neighbors are often likely to be those with whom he wor s an so
cializes and not necessarily those who live nearby. Thus t le resi en i o
the modern city is a member of that city in only a very unite
citizen of a classical city-state, who was a member o a prtvi e S
„ty, belonged to a definite social group, and knowing t 1S , °n
diet a great deal about his behavior. In modem tunes, know mg th t
person is a citizen of New York City or Minneapol.s, Minnesota,

very little about how lie is likely to behave difference between

In many respects, Greer’s the dtfeen ^ ^

the primitive social organization and the m extreme forms

sociological distinction described by Tonmes e rs-meinschatt. To quote:
of social organization, the Gesellschaft and t e

"The theory of the Gesellscliaft deals 4 rtTo^win.

an aggregate of human beings winch su P er P t0 „ e ,her peacefully- How-
schaft insofar as the individuals live P >

aver, in Gemeinschaft they remain ess ? n ‘‘“' essentially separated in
rating factors, whereas in Gesellschaft k ^ contrasted with the Ge-
sfile of all uniting factors. In the GeseUsctr , a , m a priori an d

meinschaft, we find no actions that ca ^hfc/i manifest the will

necessarily existing unity; no actions, 1 ’ no actions

and the spirit of the unity even if per/orm ^ place on behalf

which, insofar as they are formed by t e i ac tions do not exis .

of those united with him. In the “d isolated, and the reex-

On the contrary, here everybody is by 1 ot } ie rs" (Nisbet, 1966, PP-

ists a condition of tension agoins

75-76). . . especially as it

The complexity of modern ^ftoSTor dearly to identify

is found in the cities, makes it very i ^ broad definitions > a
a community. As a result, some sett e „ atte rned interactions ' ^

of Klein who regards the community a an d physical so U

domain of individuals seeking to aclu selfhood and sign

derive support in times of stress, and to This definition allows

throughout the life cycle" (K^ { act dial they do not s ^ have
one to group individuals despite t his view all J hat

geographic locus. For example, n^^unity despite £ - n ,
lost their homeland would repres { t he earth. Furt centra ted

they may be scattered over the f * iduals who are concen

definition does not imply that t

402 / the role of the community and community psycnoiogy
within a particular locale necessarily are members of the same communi-
ty. _ _

In grappling with the question of what the community actually is, we
have several times touched on the question of where it is located. This is-
iue requires a more detailed examination, since it is a very practical con-
:ern for the mental health agency that must seek to identify the comrau-
lity it serves.

Locating the Community

From the discussion above it is apparent that in complex social organi-
sations like those found in the modem urban area, geographic boundaries
either fail to designate a specific community or may encompass many dif-
ferent kinds of communities or parts thereof. This factor creates serious
practical problems for the modern-day community mental health center,
which is assigned responsibility for specific “catchment areas.” The
catchment area is a delimited geographic area that is the responsibility of
a single community mental health center. In setting up catchment areas,
it was apparently assumed that all or most of an area’s residents would
have a great deal in common. From what has been said of the problem of
defining the nature of the community, this position is only more or less
true. Commonalities may exist, but diversity is perhaps even more the
rule.

Panzetta (1971) points out that one condition which leads to a close
commonality among the residents of a particular locale is a sense of op-
pression. In such communities housing is poor, crime and death rates are
high, and infant mortality is a serious problem. These social conditions
become the symptoms” of a geographically defined community, and the
community mental health worker may make them the logical targets of
his efforts. Unfortunately, Panzetta asserts, even such seemingly tangible
and highly logical problems are not necessarily soluble within the catch-
ment area. As Panzetta states:

The dilapidated house on Diamond Street is a complex phenomenon
derived from City Hall , the money market, the suburban ethos as well as
from events and people within the catchment area. If we choose to define
our mental health goals in this grand dimension, they had better not as-
sume a catchment area orientation in our programming’ (Panzetta,

Another way in which Panzetta locates the community is in terms of
time. He points out tltat we arc all aware that a sense of community may
come and go. People unite to work toward some common goal over a pe-
riod of time, and then disband when the cause that bound them together

SOME PROBLEMS WITH THE CONCEPT OF COMMUNITY CONTROL / 405

is adequately served. From a historical perspective it is apparent that so-
cial units as complex as entire civilizations are formed and dissolved in
the same way that family structures are modified to a degree that greatly
loosens the ties of its individual members. The problem of dealing with a
time limited community is that one is hard put to predict to what degree a
particular social phenomenon is time limited, and to make a response to
it that is appropriate to its duration.

For Panzetta, the time-bound, or epiphenomenal, community requires
two conditions for its existence, oppression and leadership. The mem ers
Of such a community must share a sense of suffering and a commonality
of values and goals, but without leadership they remain ragmen e a
isolated from one another. The leader articulates their commona
binds them together as a community. . . * „ r hin

One practical implication of Pametta's viewpoint is that t ^

community mental health center may well be able to recogni ^

community or Gemeinschaft with respect 10 ' ency overcsti-

may attempt to relate to that sense of commun y. tIlc arca

mates these commonalities and romanticizes 1 Jj ts as a community

residents, it will discover soon that its chen conditions which

only to those issues that are related to the opp bc forth-

bind them together, and that sustained community in ^ limited Ge-
coming with respect to any other issues. T us on ^ established in
meinschaft can be hoped for. Many centers t a - sts f or a sense of

suburban areas operate as though little possi t ant j have con-

Gemeinschaft within its geographic area o re *P ^ specific individu-
centra ted on providing whatever services are n Gcsc i{ sC haft character
als or families. Panzetta asserts that in t ,s ca _ ropr iately» hut the agen-
of the community is being responded to nla i health service,

cy is essentially providing a traditional type o

Who Represents the Community wilhin a partial-

.Assuming that a sense of community can ntro l of a mental health

lar area, successful community involvemen w j l0 truly represent t ie

agency requires the identification of in™" dubious about the

spirit of that community. Hersch (1972) ‘^xtrem^y Panzetta

Possibility of locating such rcpresentatise n cc oi the

(1971) expresses similar doubts, an \ forccs these doubts. T ic n

>cal School controversy (Duhl. 19G9) re ^ who will n ° l rcp . wj.

l hat community representatives can Tj criC h beliesvs that
special interest gJps is seen to be vocal. or ^

« usually emerge because they arc ‘ rarely P"* 1 ^ 1 by

m °rc clever than their fellows but t ia
democratic election process.

404 } the role of the community and community psychology

Going even further, Hersch is concerned that local leaders often turn
out to be among the most pathological members of the community. He
suggests that paranoid characteristics such as intensity, a readiness to
sense persecution, a legalistic approach to issues, and a need to assert
control over situations are the very qualities that often bring community
leaders to the fore. This being the case, the power that is placed in the
hands of community representatives is often not wielded for the commu-
nity at large but, instead, to serve special personal interests. Efforts may
be made to advance the cause of one’s family members, or one’s own eth-
nic group, despite the fact that the community as a whole would be best
served by job candidates with better qualifications.

Worse yet, power may be used by community representatives for its
own sake, or as a means of expressing feelings built up over years of in-
tense frustration. When this occurs, anger is often directed at well-mean-
ing professionals who are hard put to deal with these feelings. The
professional who invites a community partnership often sees himself as a
giving, liberal person who is trying very hard to be responsive to communi-
ty needs. When he is challenged, mistrusted, and has questions raised about
his competence and integrity, his liberal, giving stance is shaken. Not un-
commonly an agency board consisting in part or entirely of community
representatives may use its powers to actually destroy professional leader-
ship. The distinction between the policy-making function of the board
and the administrative functions of the agency executives is broken down,
ending in the ultimate destruction of the agency.

Can Community Representatives Be Helpful to the Agency

Hersch (1972) points out that when the notion of community control
was introduced, it was seized on by many professionals as a panacea. This
seemed to be the ultimate mechanism whereby the poor could, at least,
begin to get service that would be meaningful to their needs, and with
which they would be comfortable. As a result, swept along on the lofty
spirit of reform, professional judgment was played down in favor of the
native wisdom of the disadvantaged. Few of the complications that have
been described above were anticipated and, as they were encountered,
much disillusionment set in.

Hersch feels that the primary problem with community control has
been the mental health professional’s tendency to romanticize the concept
in the hope that he could play a savior’s role with respect to a variety of
extraordinarily vexing and complex social problems. The danger of disil-
lusionment is that the community control concept will be rejected com-
pletely without preservation of its potentially useful aspects.

The bruises of enough agency battles indicate that there is little reason

THE LESSONS OF EXPERIENCE WITH COMMUNITY INVOLVEMENT AND CONTROL / 405

to believe that the disadvantaged, by taking matters entirely into their
own hands, will be better able to solve their problems than were the men-
tal health professionals who worked for so long in the absence of much
contact with the lower social classes. For Hersch, the choice should not
be between complete community control or complete professional con-
trol. What is necessary is a careful evaluation of what is to be gaine
from having community input and of how programs can be create to
minimize the potentially destructive effects of community invo vement.

Along somewhat similar lines, Panzetta urges that the menta ea i
agency needs to define for itself those tasks for which it is est sui
en the background and training of its professionals, and t ose or w
is not suited. Only after defining its own feasible goa is, can 1
turn to the local community for some form of help m ‘ ac

what the community's needs are. Thus the agency must be will g
cept realistic limitations to what it can accomplish.

the lessons of experience with COMMUNITY
involvement and control

The Lincoln Hospital Community Mental Health ^ jj ron x

The Lincoln Hospital Community Mental H _ . n a ce i c bratcd

New York is a prominent example of t e e £ e j(f (1972) points
mental health program by community particip ^ ^ received the Sil-

out that the mental health program at Einco ”, 1 ; a tri C Association in Oc-
ver Achievement Award of the American * 0 f psychiatric sen-

tober 1968 “in recognition of the unique co ^ ^ rnmin i in ity," V cl a short

ncmevement Award of the American 0 f psychiatric sen-

tober 1968 “in recognition of the unique co com munity,” yet a s h° rt
ices and major innovations in reaching ou ^ resl ,ltcd in the shutting
six months later a crisis over community

down of center operations. , nroblcms encounters M

It is inaccurate to place

Lincoln Hospital at the feet of the ” eI V cctly by indigenous non
encountered at that center were precipt a ^ center. An mipor

professionals employed in large num er involved the descopm

facet of Lincoln Hnsnital's outreach pro,, • cj-wribed in a pte'

ret of Lincoln Hospital's outreacn |" » /described in a P ,

neighborhood-based storefront sen ,c ^ . Lincoln hospua ® of

ia pter) , staffed largely by nonprofes ' ion s in the develop ” 1
borated with several community ^"hosc who sirongly -P
■'’ice programs and thereby allied service centers. .

«ed community control of ““^Unt debiliiamd ‘he.P^. R[Knan
The events leading up to the en c desen • «

ncoln Hospital Mental Health Ccn

406 / the role of the community and community psychology

(1969). He indicates that the background out of which conflict was to
grow including space problems, annoying bureaucratic delays, disagree-
ments between professional and nonprofessional staff concerning per-
formance evaluations, racial conflicts, and conflicts over ideological issues.
The center was affiliated with the Albert Einstein College of Medi-
cine, which had serious financial problems. Since the Lincoln program
was administered by the medical school, medical school problems inevita-
bly affected Lincoln Hospital. Personnel practices were poorly defined in
the early years of the program, there were serious delays in the payment
of the bills it incurred, petty cash funds necessary for dealing with family
emergencies uncovered through the program were limited, and salary
checks were either delayed or workers were shortchanged by mistakes in
their paychecks. While these difficulties annoyed everyone, the nonpro-
fessional staff tended to regard them as signs of exploitation and even
racism, thus heightening their distrust of the white establishment.

Against this tense background of sensitivity, annoyance, and distrust
an occasional incident occurred that seemed to foretell an eventual major
confrontation between agency nonprofessionals and professionals. One
such incident involved a conference that was to be set up concerning the
use of nonprofessionals. The funds to support the conference were pro-
vided by the Office of Economic Opportunity, and the planning group in-
cluded nonprofessionals. However, during the course of planning a ques-
tion was raised as to “whose” conference this would be. Professionals
were willing to assign major responsibilities for planning the conference
to nonprofessionals, but were unwilling to relinquish the ultimate authori-
ty of final approval. The nonprofessionals started out insisting that they
should be allowed to manage the conference but eventually demanded
that they should be assigned complete responsibility for inviting guests,
fixing the agenda, and operating the conference with no participation on
the part of professionals. As a result of this impasse, the conference was
canceled.

Roman regards the conflict over “whose” conference was being set up
as quite basic to the more serious problems that were to develop later at
the center. Essentially he views this conflict as a political question that
exposed a basic ambivalence among agency professionals concerning the
use of non professionals. While openly lauding the nonprofessional and
admiring Ins assets for performing mental health functions, few profes-
sionals were actually willing to give up their own privileged positions in a
system that assigned them high status. One prerogative deriving from this
s>stem was the power to make decisions, and professionals were altogeth-
er unwilling to relinquish this. The nonprofessionals reacted by conclud-
ing that they could never share this power that was husbanded by the
professionals short of seizing it through a dramatic coup. The resentment

THE LESSONS OF EXPERIENCE WITH COMMUNITY INVOLVEMENT AND CONTROL / 407

of the nonprofessionals over this issue was fanned, in Roman’s opinion,
by "unrealistic self-evaluations that had developed in the minds of the
nonprofessionals.” These misleading self-evaluations were encouraged by
the “rhetoric” of the storefront program’s first director who drummed
into the nonprofessionals the idea that they could teach professionals
more than they could learn from them.

The Lincoln Hospital nonprofessionals reacted to the power differen-
tial in several ways. One way was to resist passively any decisions arrive
at by professionals. Another involved demands for access to pro essiona
credentialing that would make it possible for the nonprofessiona to wo
his way up into the decision-making hierarchy. Eventually discouraged
by the amount of time required to make even minimal c anges m
ired direction, nonprofessionals began to demand status in e
of experience or the opportunity to gain additiona ere en ia •
loin UW, JSrfnn for reDlacins the white supervisor became

ay up into the decision-making hierarchy. r.ve y
, amount of time required to make even minimal c ranges * n
sired direction, nonprofessionals l>egan to deman * tatu ^ in , .

of experience or the opportunity to gain additiona ere en ia • ;

point, their primary criterion for replacing the white supervi
racial one. Blackness was regarded as the only mark o egi experi-
Beginning in May 19G8 the Lincoln Hospieal Center ^
ence a series of major confrontations that ulti y nnnnro fessionals
Its service programs. One involved a sit-in on t epar ^ o£ deroan ds,
in the hospital business administrator’s office w nraC tices to the ai-
ding from the resolution of grievances over P a ^ upgrading the

lotment of educational release time and free u Qther se rious con-
skills of the nonprofessional staff, were issue . ' a demand was
frontations involved the professional sta . " . te more authority

made for an internal reorganization that wou , stoppage was held

t0 the professional staff. In the second instance a ^ ^ limited,
following an announcement that salary incremen . . trat j ve structure to
When a plan for reorganizing the center s directors was pre-

delegate more authority to service chie s an . opposition because
sented to the total staff, it was met with consi lta *j on of “all levels
the reorganization was developed without the “ ^ disciplines,
°1 Staff." Tints a new committee was form nted . The charge of

h °th professionals and nonprofessionals, were F and review board
this new group was to develop a p° icy r t he entire center P r

( PPR B) . This body was to have veto P“*. 0 pe ra tion were spen

Siam. The first few months of the new co and how it wou

debam over what powers the PPRB was 'oja ^ ^ advisory capa«W
“mposed. Some argued that it could only . officially design i

it could not usurp the power of the prog™ [he PP RB shotdd

irector. The nonprofessionals took the ’tarn* ( have veto and

insist primarily of nonprofessionals an the PPRB

^icy-making powers. In essence, tins group f ^ possible form
:erve - -- • ■ - f the aeency unlit

«t primarily of nonprotesstut. fcIt tha t me a

ey-making powers. In essence, this gr r was possible w
e as the directing board of the agenc

408 / the role of the community and community psychology
board consisting of community consumers. The nonprofessionals justified
their position on the grounds that they were of the community, they knew
more about it than anyone else in the agency, and they were in a position
to legitimately act for agency consumers until the community could form
its own representative group.

Opposition to the formation of the PPRB in the image described by
the nonprofessionals was based on the concern that the formation of such
a board would actually retard the development of community control.
Some doubted that the nonprofessionals would be willing to relinquish
their newly acquired power to the community and, more important, it
was felt that the nonprofessionals themselves, as service providers, should
be responsible to a consumer board. Despite these objections, the Lincoln
Hospital Center director supported the nonprofessionals’ plan and sought
the approval of the medical school dean in implementing it. That approv-
al was refused on the grounds that the center's director did not have the
authority to create such a board, and that setting up a body of this kind
violated the contract that the agency had with the city of New York.
Some nonprofessionals as well as professionals were relieved at this out-
come since, they believed, the creation of such a board was simply a
power grab for a militant minority. Many, however, reacted with con-
siderable anger, feeling that the center’s director had led them to believe
that they were making some headway while he knew full well that the
plan would be vetoed at a higher level.

This setback for the nonprofessionals was followed by a relatively
quiescent period at the center that culminated in a major crisis in March
1969. During this period of calm, Roman points out, a power struggle
was taking place within the community between a leader of the black mil*
itant faction, who happened to be a nonprofessional at the center, and
one of the major leaders of the Puerto Rican community. In this struggle,
the Puerto Rican leader emerged as the winner after a prolonged and bit-
ter struggle. Roman believes that the defeats suffered by several of the
Lincoln Hospital nonprofessionals who were involved in this power strug-
gle intensified their need to establish a political base through the Lincoln
program. The incident that touched off the crucial confrontation at Lin-
coln Hospital was the firing of a recently hired black nonprofessional. Al-
though most workers seemed to acknowledge that the firing was appro-
priate, their leaders argued that agreed on procedures for dismissing an
employee had not been followed by the administration. A search was
made for additional issues on which to base a major confrontation, and
there ensued a series of accusations against the administration concerning
alleged racist practices, malfeasance, misuse of funds, and the like.

Amid the turbulancc that followed, a work stoppage was declared,
buildings were occupied, nonstrikers were locked out, and nonprofession-
als took over as chiefs of the various services. Some professionals sup-

THE LESSONS OF EXPERIENCE WITH COMMUNITY INVOLVEMENT AND CONTROL / 409

ported the “work in, ’ accepted the authority of nonprofessionals and
continued to work in their services as consultants The program was de
clared the people's Mental Health Center Mark Rudd of Students for
a Democratic Society (SDS) entered the scene to lend his support to the
striking staff as did members of the Black Panthers On the other hand
the Mental Health Workers Union refused to support the strike regard
mg it as illegal, and it seems apparent that the movement received rela
tively little support from the local community, which was 70 percent
Puerto Rican One community organizer remarked, Baby this is some
peoples' revolution, you got white shrinks from Westchester the V ag
posters of Che and Malcolm, but there am t a Puerto Rican button in
sight ”

On March 6, the Lincoln Hospital Mental Health Center director a ‘
knowledged the impossibility of maintaining a liaison between pro
als attempting to maintain service at Lincoln and the a mimstra i
exile, and notified the City Hospital Commissioner that he cou %

er accept responsibility for patient care At S r m that day
the mental health services at Lincoln nroeram

In the next few weeks efforts were made to revl '' e ]u dmg some

hut these proved to be ineffective The professiona to ot i, er

°f the psychiatrists who supported the strike iegan

mbs At the time of Roman s report efforts were still ^

Vlve the program at Lincoln Hospital but c ear y a 1 ^^bled at
stood out as a beacon on the mental health cen er s members

'east part, as the result of ns nonon of c°nimun,ty con

Despite this Roman continues to support alienation of the

hoi and continues to find in it the only solution for the
ghetto dweller from the immediacy of hfe

^he Temple University Community Mental H ^ ^

Panzetta (1971) considers that there are two Jfhealth center One is
community can play in its relationship to a me conSU mer As a fran
as the franchiser of the agency and the other 1 an( j has effective

chiser, the community essentially sponsors me age , fa „ th at

control of its program, its personnel an 1 unlt y to * confront i

'his would seem to be an ideal way for the c hijer relationship «

s'ltutions that should serve it Panzetta sees the dclc!op rcpr escnla

- Hy not workable because communities rare ^ com

r ho can speak authoritatively for the g™ * P 2 genc> is simpb l!nc ^ r
' representatives fail to truly represen^ n0 t even serve co

ltrol nf n r>*»y.r ct vrial interest group o rurencics

*ield con

410 / the role of the community and community psychology
siderable influence Since the agency goal is to provide services, the
choice o£ using or rejecting these services can exercise a powerful control
over the agency functions On the other hand, for consumer power to be
most effective, it must operate in a free market where the consumer has
the option of accepting the services of one agency and rejecting the serv
ices of another The catchment area principle, which is built into the
community mental health center structure, although attractive because it
clearly allocates responsibility for designated geographical areas to specif
ic centers actually denies the consumer the right of free choice If he
lives m a catchment area, he must go to the particular mental health cen
ter serving it Thus his choice is between a given center or nothing, and
as a consumer his power to influence agency function is greatly dimin
ished

Wearing the scars of his experience m a very forward looking mental
health center in Philadelphia, Panzetta makes some specific recommenda
tions about the way out of the dilemma of reconciling agency functions to
community needs He suggests first that the search for the ' community"
be abandoned entirely More important than locating the community, is
having the center establish an identity of its own That is, it must know
before it opens its doors what it can and cannot do Once a clear sense of
identity is established it should then turn to the community to make that
identity known Part of the process of establishing an internal identity
should be a rational decision about the degree to which agency decision
makers wish to balance their own views by including community mem
bers who may be identified as (a) residents of the area, (b) interested in
t ic center’s work (c) able to conceptualize the problems faced and the
potential solutions involved, and (d) , m participating having a willing
ness to oth disagree as well as agree The incorporation of such com
munity residents on the center s board is not thought by Panzetta to be
entirely necessary Some centers may not wish to have these board mem
bers and will very hkely be less sensitive to area needs than they might
otherwise be While this is not an ideal situation, in the last analysis
agency professionals must perform the service, and they must do so un
der circumstances m which they are comfortable One way centers may
choose to maintain a sensitivity to area needs is by hiring area residents
Panzetta asserts that the indigenous nonprofessional may serve a more
significant role in the agency because he can help sensitize it to area
needs than because of the manpower function he fulfills
Panzetta carefull> underscores the point that the mental health profes
sional must accept the fact that his professional skills prepare him to deal
effective^ with some kinds of problems but not with other kinds He sug
gests that because the rise of the community movement has paralleled the
black revolution man) professionals in the community have taken on the

THE LESSONS OF EXPERIENCE WITH COMMUNITY INVOLVEMENT AND CONTROL / 411

cause of the downtrodden blacks While this is justifiable on some
grounds, he feels that the enthusiasm and energy thrown into this move
ment has created a series of illusory goals that are only vaguely related to
the concept of mental health The community movement may, therefore,
have stepped out of its proper arena and into one in which it is ultimately
doomed to frustration The black revolution is seen by Panzetta as a
movement that affects deeply the entire fabric of our social structure,
and professionals, as private citizens, may wish to play a role in it The
community approach to mental health is interpreted as a move rom a
narrow conception of the way mental illness comes about, an °' v
should be treated, toward a broader view, the borders of which are stu
ill defined The goals of each of these noble efforts Panzetta regards as
separate and unique

The Denver Model Cities Program

Wh, taker (1970) has descnbed h.s Modd «

penment initiated m Denver in the spring of 19 nrnnr . ate for the
been made available to develop mental health se ™“”^ many different
urban poor Ghetto problems were to be abac e expression,

directions including education employment ica , 0K pr0 blems

and physical planning Furthermore the S hett ° lhe panning of
were to be dealt with were to be allowed to participat

Initially, the professionals involved in the P !a "" 1 'L® 1 j en ° s w ho were to
week with officials of the city government while t ^ ^ ^ , he car
participate met separately Eventually on a ov , ^ meals, a

ly summer at a recreational site in the cotm^ 5 j. e r 197 O p 2004), the
luxurious pool, and other recreations (V 1 3 art ,opating residents "3 s
first major meeting between professionals and p ^ and suspicion
held Despite the elegance of the setting an ^ ' j ever read) to erupt
"ere the guests ' The anger of the resi J- nts might seem qmte m

at topics that they found controversial, t oug ^ lhc ^ 0 rd computer
nocent to the professionals For example, tn s from som e male

fa y one white professional brought forth *-j* 8 o[ ocn a single resi

Mack residents Even more ominous was <he

dent to appear for a discussion of healt p an . stressed the 0°° °

After this initial meeting some and a concerted

greater resident participation in the pi™”* Jj ate ° 0 n 12 committees
effort was made to recruit residents to pa . i e m t j, e planning gr
J h,s P Qi nt it became clear that the major P Mlhiant group* **j of
faced was the apathy of the resident pop j vcd and ''ere capa
the Black Panthers could become intense >

412 f the role of the community and community psychology

working very energetically and constructively, as well as being destruc-
tive. Recruiting other residents, however, was difficult, and it also became
apparent that professionals were apathetic about and poorly educated for
the task of working with residents. Despite these obstacles, the difficulty
in staffing committees was overcome, and even the health committee
found enough members to pursue its task.

Whitaker became the technical adviser to the mental health planning
committee, and much of his paper describes his experience in that role.
Progress in the committee function was made inch by inch and only after
cultivating the personal trust and understanding of individual residents.
Movement was agonizingly slow and painful and, on many occasions,
Whitaker was tempted to withdraw from the committee. One such occa-
sion was prompted by the personal attacks of some residents that shook
Whitaker’s self-esteem. On another occasion, the rigidity and shortsight-
edness of establishment people seemed to be a permanent barrier to fur-
ther progress. On still another occasion, the combination of the demands
of other professional activities in addition to the committee work prompt-
ed the impulse to give up.

Whitaker compares the process engaged in by the committee to group
therapy or to an encounter group where all participants are sometimes
patients and sometimes therapists. He numbered among his own major
therapists a half black and half Hispano woman who chaired the commit-
tee and was effective at getting a mixed group to work together. Another
was a rugged black man who, although verbally articulate, displayed a
persistent sense of goodwill and a deep intuitive understanding of person-
ality. Despite the agonies of the process, Whitaker reports that a number
of projects were planned that had considerable relevance for the prob-
lems faced in the ghetto community.

Whitaker s three major conclusions as a result of his experience is that
the greatest challenge in effective planning for Model Cities programs
that involve community participation is not a technical one. Instead, it is
a challenge of interpersonal relationships. Empathy, a willingness to
share power, strong motivation for social reform, and enormous patience
are absolutely necessary for the effective use of technical skills. A second
conclusion is that to promote maximum feasible participation by the
community in planning, intensive efforts must be made to develop appro-
priate interpersonal skills among all who participate in the collaboration
between residents and establishment people. Professionals must, there-
fore, receive some of their education in the ghetto as well as in the uni-
versity. Whitaker's third recommendation is that the universities inject
into formal education a considerably greater effort to develop value sys-
tems that encourage the development of socially constructive action. In
the absence of such guidance, students have had to develop their own

THE LEMON'S OF EtrEBIENCE WSTII COMMUNITY INVOLVEMENT AND CONTROL / 413

causes, and frequently these have led to distressing student uprisings. If
faculty demonstrated a personal involvement in meaningful social issues,
students might well identify with them and devote their energies to so \
ing such important problems.

Community Participation in a Neighborhood Mental Health
Center

Salber (1970) is a former director of a neighborhood health ^ ^
that invited community participation in directing t e agen . m

fered both her subjective impressions of these experiences Salber
mendations concerning how best to impleme, » ‘ t * ^
identifies two extreme positions that may be ta community in-

munity participation. At one extreme, involving mim uent iy with

volvemcnt, a committee of residents is forme to m neJ hbor i 100 d, and
board members of the agency at a place otitsi e * (hat h as been

these residents simply provide advice concerning ‘ and the a dvi-
set up. Significant decisions are not made extreme ,’ neighborhood
sory committee’s power is minimal. At tt agency. They

residents hold all or most of the administrative ot j ier a g e ncies to

control the budget, hire the staff, and contrac ' ^ t0 favor a

provide necessary sendees. Salber’s own ex P ene extre mes. Here an in-
partnership model, a compromise between t ie * of a g enC y profes-
formed neighborhood group serves along wi 1 ^ partners in making

sionals who agree to share power and to oper

decisions. , . uiuhed neighborhood health

A major problem faced by the new y * nei vhborhood residents an
center is the unrealistic expectancies of bot . d Area residents are
agency staff concerning what can be ? cc ° . | jp ne sses will be cure ,
' apt to think that at long last all of t eir P w yj ^ corrected, tliat a

that unsanitary conditions in the neig 1 or landlords will repair t iei

coholism and drug problems will dummy. ‘ will reliably P^°f

property, and that increased numbers of P^ervices will be avail ble

, They expect that agency se r tuh

them

night ^d^a^tiiat'^oc.o'rs 'vvill'make^house ^'^ 'ijc'piokwl aher i^day-
he available when needed, that their c 1 ^ able to care ,

care centers, and that, being rich, the a S*" expectations arc 1,0 'j ul
without any financial constraints. Unre. sta [f ; s often )

sive to the residents, however. The lia ive about .he P^^

and idealistic, deeply devoted to Pf‘ en “’ ^ ^ermines both the * ^
cal and economic structure of socie y • pfe-styles of neig
the agency itself and, to a great
residents who are their clients. Such p

414 / the role of the community and community psychology
relatively moderate salaries and expect their major rewards to come from
the satisfaction of serving their fellow men who are deeply in need. Thus
they are ill-prepared to cope with the militant or angry patient, or with
patients who are lackadaisical about keeping scheduled appointments,
who come in late, or who come in without appointments at all and expect
to be seen.

Salber feels that it is essential to adjust these unrealistic expectations
on the part of both neighborhood residents and staff by establishing bet-
ter communication channels. But improved communication is not easily
come by. One approach is to employ community residents as much as
possible in the agency. The indigenous employee can educate the agency
staff concerning the neighborhood and can also serve as a bridge from
professional staff to the neighborhood and its residents. They also make
the center more appealing and approachable for neighborhood residents.
The lower classes often feel intimidated by middle class professionals and
are less comfortable bringing complaints and requests for service to them
than they are to staff members who are seen to come from their own so-
cial class. But the device of employing neighborhood residents does not
entirely solve the problem of establishing effective communication be-
tween agency staff and area residents. To some extent, it creates addi-
tional problems. Resident employees often fail to adhere to middle class
standards of punctuality, may be unaccustomed to a daily work routine,
may have difficulty arranging for the care of their children while they are
away at work, and may react badly to the criticism of supervisory person-
nel.

A major impediment identified by Salber in achieving effective com-
munication between professionals and neighborhood residents is the fact
that neither really listens to the other. Meetings between professionals
and resident groups are characterized by much shouting and little rea-
soned argument on either side. Community residents are generally bitter
over previous experiences with agencies which have made them suspi-
cious and distrustful. Professionals often respond to this feeling with re-
straint but harbor their own sense of bitterness and frustration which they
release only at private meetings of peer groups. A major reason for the
gap between the professional and the community resident is that, when
both groups do come together, the professionals regard themselves as
sendee providers and the residents as service recipients. They do not
meet on common ground as human beings either in a social context or as
partners in the solution of a problem. For this reason, professionals often
find it difficult to accept community members in either participatory or
decision-making roles. On the other hand, community people tend to
oversimplify the professional's job and often think that he can easily be re-
placed by people with no theoretical background or special training. Thus

THE LESSONS OF EXPERIENCE WITH COMMUNITY INVOLVEMENT AND CONTROL / 415

both agency professional staff and residents need extensive training in
communicating with each other

Salber recommends that the agency director establish a long range ed
ucational program for the institutions that sponsor the center, the area
residents who are selected to serve on advisory committees, and the agen
cy staff Sponsoring institutions can be acquainted with the neighbor
hood s problems by having their directors meet with area residents at the
agency Staff members’ attitudes can be dealt with through in service
training programs and by participation in programs in which they must
function jointly with community residents Salber believes that tee uca
tion of the area residents serving on boards is probably the easiest o ie
three programs to mount since residents tend to be eager ear !L?"
are drawn enthusiastically to the new opportunities o ere 1 ** rn
training however, must extend beyond the bounds o iea i
into issues such as governmental structure and financing t ie ^

and function of committees, education concerning present to

hvery systems some notion of how budgets are set up, an
the job functions of different agency personnel , me r S and

Ideally, Salber feels that such a P art "" sh ' P h ™ ccnter begins oper
agency professionals should be developed bef dcnts participa

ating This reflects the interest of the agency in beeinning Also,

tion and ensures that realistic goals will be set rom p-icianccs

the machinery for hiring and firing personnel an ° ^ ru ] es IS e s-

must be created in advance so that a common se c ] a5 j lcs 0 tcr the

tabhshed for all who are involved, thereby mimmizi g
mechanics of the operation

The Hill-West Haven Experience ^

Tischler (1971) has described the community .^^^nccticut Mental
'eloped at the Hill West Haven division o ^ that because tM
Health Center This agency operates on t » Y h hc In s to It se, he
consumer has 4 savvy about the a jiencies and is awa J c °

aus e he recognizes the complexities o se hfe situation ' c

ict that these aaences can have on his °' ,ce 1**

iUse he recognizes the complexities o se oun hfe situation ' c

lc impact that these agencies can have on con ,niunii> sen'" P
utually obligated to participate in setting

turns m it\ residents lnd

At the outset at Hill West Haven, the f aulho nl> »« "

n informal involvement with the agency advice and opinion

0 community participants and. althotig 1 ^ n0 powers uu .

'ming program goals and policies ^ 51Iua „on P" v31 ^
n community representatives In I 5 * narticip 1 ^ 1

be cuclimcnt area lacked tlic organimti

416 / the role of the community and community psychology

tion of health and social services. The initial task, therefore, required or-
ganizing the community through work with specific groups and other
agencies to set up structures to represent the community with respect to
health and social services. This phase required a period of about three
years following which a consumer board was set up to which the agency
became accountable. Board responsibility encompassed program devel-
opment, personnel practices, and the establishment of service and re-
search priorities. Any changes in the basic agency structure or direction
required board approval which could initiate changes as well.

The impact of the shift from informal consumer participation in agen-
cy functioning to a formalized role involving consumer control was evalu-
ated from two viewpoints, the structural and the functional. Structurally,
Tischler reports that the affect of the transmission was minimal. The
agency continued to be organized much as it had been before consumer
control was a fact, and it offered services similar to those provided pre-
viously. The board assigned priority to services for the elderly and for
children, with reallocations of personnel in keeping with these priorities.
Community residents were included in greater numbers on the agency
staff. An in-service training program was also set up to acquaint the staff
with the life situation and particularly with the needs of the poor.

The functional changes that came about through the advent of com-
munity control involved modifications in the way much of the staff per-
formed. Therefore, service delivery was clearly affected by the organiza-
tional shift. Tischler identifies four types of staff response during the
transition period.

Some staff feared that the consumer would be entirely irrational and
that caregivers would be turned on and destroyed by the anger and vin-
dictiveness of community residents. From this viewpoint, turning control
of the agency over to the consumer simply invited anarchy. These staff
members felt that things were slipping out of their control; rumors about
rape and theft in the parking lot proliferated, and there was much con-
cern about the possibility that the staff would be assaulted. Anxiety
among staff feeling this way was so intense that they were functionally
“paralyzed” and incapable of meeting their responsibilities.

A second response pattern that resulted in a lessening of the quality of
service was to deny that consumer control could ever be a reality. Some
staff simply went along insisting to themselves and others that the status
quo would remain essentially unshaken. They regarded efforts to institute
consumer control to be an inconvenience imposed on them by a leader-
ship that had failed to educate the community properly concerning the
unshakcablc realities in the mental health field. Such staff maintained
that if the community were acquainted with these realities, it would have
no interest in becoming involved in the management of mental health

CONCLUSION / 417

agencies. Staff members holding this view tended to become constricted
in their functioning, and their lessened flexibility impaired their capacity
to listen.

A third response pattern that compromised the quality of staff per-
formance involved a complete surrender to community control. Staff
members taking this position stood in awe of the consumers expertise.
They studied recent literature of the black movement carefully and dis-
cussed it with a reverence once reserved only for the towering figures in
social work, psychiatry, and psychology. These staff members became
dilletantes without a clear focus on their work with clients.

The most common response pattern found among staff of t e agency
described by Tischler might be characterized as an acceptance of t e c -
sumer as a collaborator combined with some sense of anxiety a ou
this collaboration would work out. The anxiety was associated with urn
certainty about how a consumer controlled hoard migit c a 8 tQ

service patterns, might alter established priorities, an . ® idu ^ t reat-

which it might attempt to engage in the prescription 01 ^ recogn j ze d
ment patterns. For such staff members, consumer tQ be more

as an opportunity for truly innovative programs 1 * rema j n ed that a
effective than traditional ones, but the naggi g many current

board which reorders basic priorities mig t we j. was toward a
staff from their jobs. Despite these concerns, t ie $taff me mbers,

general positive reaction to consumer contro ana0 outcome of the

and there was a willingness to base their judgmen s
venture on unfolding experience. efforts to institute

Tischler concludes his description of one ag * its appa rent success,
community control on a conservative note, es P of agency re-

He recognizes that the process of bringing a ° ompan ied by considerable
organization is slow and that it is inevita > 2 es ex j st that service

strain. Furthermore, he points out that no gn wilI make fewer

will be more responsive to society’s needs or de(J as a collaborator,

demands on the agency when the consumer >s ib ility between sen-

He does argue, however, that the sharing o { or those served an

ic e providers and consumers holds greater p than do the more

Potentially greater rewards for those w o a
rigid traditional mental health care systems.

CONCLUSION ndemned as insensitive

Traditional mental health agencies have b “" « „[ our society. An

_ v . , lor-rrf seemew

vious

unresponsive to the i».w — .

way of heightening agency sensitivi

h agencies have our s0Cie ty. -

needs of large segment ^ of the po.ent.al

418 / the role of the community and community psychology
consumers is to invite consumer involvement or, in some instances actual
control of the agency Implementation of such programs, however, in
volves a variety of problems The first concerns the confusion over how
actually to define the community and how to locate it Establishment of
catchment areas of responsibility for specific community mental health
centers actually compounds the problem instead of resolving it Other
problems in setting up effective community control involve the identifica
tion of representatives who can act for the community as a whole, the
avoidance of special interest power groups within the community, and the
overreliance on what may be an illusory expertise attributed to commum
ty members Descriptions of agency programs in which efforts were made
to incorporate community members on boards reflect considerable strain,
seemingly wasted time, and much animosity between professionals and
community members The success of these programs demands considera
ble patience, the goodwill of both professionals and consumers, and the
willingness of professionals to put up with many indignities

Because within a given agency s area of responsibility, many different
communities and social problems may exist, it is vital that the agency de
fine for itself which community it will serve and which problems it can be
realistically expected to address Having established such an identity, it is
probably only then feasible to invite consumer participation in a form ap-
propriate to agency goals and staff needs

References

Brcdemcier H C The socially handicapped and the agencies a market analysis
In 7 Riessman J Cohen, and A Pearl (Eds), The mental health of the
poor New York Free Press 1964 Pp 96-109
Duhl L Newark Community or chaos Journal of Applied Behavioral Science,
1969, 5, 535-572

Greer, S Social Organization New York Random House 1955
Hersdi C Social history, mental health, and community control American
Psychologist, 1972 27,749-754

Klein D C Community dynamics and mental health New York Wiley, 1968
Ntsbct R A The Sociological Tradition New York Basic Books, 1966
Panzetta A F Community mental health myth and reality Philadelphia Lea &.
Febigcr, 1971

Reiff R. The wreck of the Lincoln lightship or clinician, heal thyself
Unpublished manuscript Albert Einstein College of Medicine, 1972
Roman, M Community control and the community mental health center* a wew
from the Lincoln bridge Presented at NIMH stall meeting on Metropolitan

REFERENCES / 419

Topics— Dilemma of Community Control University and Community
Relations, No\ 21, 19G9, Washington, DC
Salber, E J Community participation in neighborhood health centers New
England Journal of Medicine , 1970 283, 515-518
Smith, M B , &. Hobbs, N The community and the community mental health
center American Psychologist , 1966,27,499-509
Tischler, G L The effects of consumer control on the delivery of services
American Journal of Orthopsychiatry, 1971, 77, 501-505
Tofiler, A ruture Shock New York Random House 1970
Whitaker, L Social reform and the comprehensive community mental health
center the model cities experiment American Journal of Public Health,
1970, 60 2005-2010

I 5- i esearch in community psychology

Community psychology is very much in its infancy. As such, a great
who^inne'd st"?. P r0srams lllve becn seated by energetic professionals
loZ nT Pr T amS WiU mect important human needs. The

nmntioned '’T'™,'' “ ^ °" °* ‘he best hunches of well-

mmntmncd workers. In the rush to develop service programs suited to

Tm s £ fiLT - A r' y mtlC cf[ort been devoted to es-
mbhslung firm empmcal bases for what gets done and the way it gets

Severn, Who are identified with the community psychology movement
plead for sertous attention to the research enterprise, particularly at this
' 5,a8 ' : I ° " ,C f ! c d 5 development. As Cowen (19G7, p. -MS)

stams the future shape of the mental health order can only be gov-

erned by empmes winch are. as yet, unknown to us. This means that
cotnpreI.ens.ve and soplusl, rated research is a necessity of the highest
pnomy ,f we are to aspire to sound and orderly progress in the decades

RESEARCH IN COMMUNITY PSYCHOLOGY / 421

to come " In essence he feels that the discouragement with the old mental
health order that led to the de\elopment of community psychology was
to some extent, rooted in the fact that traditional approaches were based
on a faith that professionals eventually came to feel was unjustified Cow
en hopes for a firmer foundation than simple faith for the community
psychology mo\ement A somewhat similar point is made by Edgerton
(1971, p 89) who writes, ' Our present opportunity is reminiscent of the
situation confronting the long ago motorist on the midwestern plains w o
came to a sign which read, ‘Choose your ruts, you 11 be m t em or t e
next 50 miles ' ” Since community psychology may be in t e position
forming ruts in which it will remain for the next 50 years get on
gards it as vitally important that they be formed on the asis o
valid data that can be collected at this time , . 1S

This support for research in the community menta ea ^
found among the spokesmen for large profession organiza
as m the mandates set forth by the federal g°«r^ent which funds^
great deal of research in the mental health fields ger f jggg as we ll
example, that the Commnn.ty Mental Health ele

as its amended form in 19&5 stresses researc 1 a center Further

ment of the services of a comprehensive menta ea ^ federal gov

raore a small fraction of the monies made avai services can be

ernment for the creation of comprehensive P u 1C , ji] ne ss and Health
used for research The Joint Commission on e ” , f or patient serv
(1961) has recommended that 2i/£ percent o t e in their position

tees be allotted for research Smith and Ho ) s sOCia tion call for set
paper representing the American Psycho community mental

tin g aside 5 to 10 percent of the budget o Some (Cowen 1967)
health center for program evaluation an — „A*nne tl

regard these percentages as niggardly an , ” s t he mandate for pursu

nificance of the research enterprise Nevert ie a sina fl scale, is P re ^

ln 8 research and the means for doing it, at t to apply his TCS€ ?*t,
e nt Thus it behooves the community psyc com munity psycb°
skills to foster a more • orderly development t «* ^ steeped ajxa*

Despite the fact that the training of p y eng age in many ty Pf
hon of research relatively few are prepare : As several "Tim”

research that are relevant to community psy _ 3 most imp

Pointed out (Cohen. 1966, Miller, 1970 R ^ o[ die social l
research area for community psychology force s can aid or det ” 1!y fo-
on man and the way ,n which 4*^ b „ e tmd.uon^
his optimal development Whereas p y 3Jld bis interna P ‘ re .

^sed on laboratory studies of the indiv ^ slgnlfic ant socta /methods
the type of research that will shed lig Such studies into
Quires a study of man in his natural a

considering the sig

422 / research in community psychology

and procedures that are relatively foreign to most psychologists Proce
dures of this hind have been worked out in other fields, for example, the
study of epidemiology in public health medicine Other such approaches
are only just being worked out within areas such as social psychology
Thus the researcher in community psychology will often find it necessary
to adopt methods that are traditionally associated with other fields, or to
participate in the development of new research methods to answer the
kinds of questions that will make possible the advancement of his field
To be sure, some research particularly that involving program evalua
tion, will be familiar to the traditionally trained psychologist without re
quiring a major retooling effort In this chapter we describe various types
of research approaches that are particularly relevant to community psy
chology

EPIDEMIOLOGY

Epidemiology is a research approach that was developed in public health
medicine and is concerned with understanding the spread of disease
Doull (1952) defines epidemiology as the study and interpretation of
the mass phenomena of health and disease ” The unit of study in epide
miology is the population group rather than the single individual Ideally
its methodology involves the comparison of the incidence of a disease
process in groups similar to each other with respect to all significant van
ables but one Originally the approach was developed to understand and
control the spread of epidemics but ns scope within medicine has been
extended to include infectious diseases such as leprosy, syphillis, and tub
erculosis which do not ordinarily result in epidemics To date nonmfec
tious diseases such as accidents and even measurable physiological at
tributes hive been included in epidemiological studies
The science of epidemiology draws its facts from the medical sciences
an other sources such as sociology, demography and statistics, engineer
ing meteorology and geography The relationship between facts derived
from these areas and previous knowledge of a subject should provide a
basis for inferences concerning the likely cause of either a localized epi
domic or the basis for the incidence of some disorder One such expla
nations are arrived at, one can hopefully take steps to prevent the further
progress of disease processes As previously mentioned, one of the classic
examples of tins use of epidemiology involves the work of Snow (Mac
Mahon and Pugh 1970) who was able to stem a cholera epidemic m
mid 19th centun London after finding that most of those coming down
with the disease were being furnished their water b> particular suppliers

EPIDEMIOLOGY / 423

Prevention in that case simply involved removing the pump handles from
the suspect wells

An essential aspect of descriptive epidemiology is the measurement of
disease frequency, since it permits comparison between populations and
subgroups within populations (MacMahon and Pugh, 1970) The sim
plest disease frequency statement might read, ' There are 500 cases of
tuberculosis ” This requires only a simple count of identified cases Such
a statement, however, is not very useful until it is qualified with respect
to (a) the population to which it refers, and (b) when these cases were
identified Thus a more useful statement would read, "On January -
1970, 500 cases of tuberculosis v\ere identified m a given town
this statement would be useful for planning health facilities m a P ar : ' C
town, it would still be of limited value if one were concerne vvi
paring one town to another to determine whether factors ea 1 g
development of tuberculosis were stronger in one or t e o e
cies may vary between two given locales simply because ° jikely

m population between them New York City, for “““Pf ’ beca use of the
have more cases of most d.seases than But* .Montana bemuse^ ^
population differential, even if the factors leach g frequen

Prevalent in New York To account for population differences,
cies must be expressed in terms of rates f t i nne measured

The dictionary definition of a rate is a measured ’ is the

per unit of something else ” In epidemiology , e j se » 1S the popu
disease or trait under study and the “unit o some cases are iden

lation from which the cases are drawn The time ^ The frequency

tified is, of course, a third essential fact in epi e ^ ^ expressed as

of tuberculosis on January 1, 1970 in a given ci ^ actual practice,

500 cases per the two million inhabitants o t n0t m relation to

ra pid comparison of rates is facilitated b> sta ,n uni t of population

total populations but with respect to some conv ^ Q 25 per thou

Sl2e (usually some power of 10) such as 0 P y dlV idmg the num

sand, nrocn ii.„„ c,.c-u fioiires are arrivea aL ^ _ , ocnlf by

as 0 025 P eix ‘ \ he num

\ owarv. , t by dividing

t Or 250 per million Such figures are arri the result by the se

ber of cases by the population figure and multip Y ^ 8 ^ nurne rator and
lected unit of size Care must be taken to e ^ t j ie numerator re
tbe denominator of a rate m the same terms mUSt be true for t ie
to a specific age, sex, or racial group, t ie s

nominator , stu dy the occurrenc

Two indexes that are very commonly ups are tTtctd . e " C * caS .

disease or behavioral disorders in popn «« t he number o

Prevalent v ,ias7V defines incidence as It lS necessary

f cases 1

Prevalence Kramer (1957) defines inCI ° e " d G f time ’ It lS itb
es of a disease occurring within a specific pe ^ disease or disorder
define “new cases” as the first occurren

424 / research in community psychology

in a given individual's lifetime. The incidence rate is the ratio between
the number of new cases, however defined, occurring within the specified
interval and the total number in the population exposed to risk. Incidence
rates may be specified with respect to many factors such as age, sex, mar-
ital status, geographic area, and socioeconomic status.

Prevalence is a measure of the number of cases of a disease or disorda-
present in a population group during a specified interval of time. That is,
it includes incidence, since it is a combination of the number of cases that
exist at the time the interval under study begins plus the number of new
cases that develop during that interval. Thus it is crucial in quoting prev-
alence figures to specify the length of the interval under consideration.
One can speak, of the number of people who suffer a disorder during a
given day, a given week, or during intervals as long as a month or a year.
It is also necessary that the characteristics of those included as cases dur-
ing such an interval be defined very carefully. The prevalence rate is the
ratio between the number of cases found in a specified interval and the
number of people in the appropriate population under study. As in the
case of incidence rates, prevalence rates can be specified for particular
age groups, sex categories, geographic areas, or socioeconomic groups. Al-
though the incidence rate is regarded by Kramer (1957) as the funda-
mental epidemiological ratio, the prevalence rate is probably the one that
is more easily determined, since it can be arrived at by simply-counting
all cases of a disorder within a population group at some point in time.

It is well recognized within public health medicine that, assuming all
individuals are equally subject to exposure to bacteria causing infectious
diseases, the incidence of the disease is a function of the balance between
the resistance of the population and the potency of the microorganisms
causing the disease. Such a balance is referred to as the force of morbidi-
ty. In the case of a mental disorder, these rates would very likely depend
on the balance between the resistance of the population to the disorder
and those environmental forces — biological, cultural, psychological — that
produce the stress which causes mental disorder. Prevalence, on the other
hand, is a more complex concept. It is determined by both the force of
morbidity and the interval between the onset and termination of a disor-
der. Thus prevalence rate is a function of both the incidence rate and the
duration of the disorder.

Kramer (1957) illustrates this distinction through the use of three hy-
pothetical examples in which incidence, duration, and 'prevalence vary.
He conjures up three imaginary communities each having a stationary
population of 100,000 which have been entirely free of mental disorder.
Suddenly on January 1, 1940 in communities A and B, respectively,
1000 people, and in community C, 2000 people succumb to psychosis.
Further simplifying, he assumes that they are all hospitalized immediately

rrrrucoiiDCT / 423

2 nd that all suffer the same mental di-order For each of the 10 following
years Kramer also assumes that on everv Januarv 1, 1000 new ca^es of
the same disorder appear in \ and B and 2000 appear in C. Further
more, he assumes that in each community a fixed number of individuals
are released from the hospital at some specified rate as cured of them dis-
order, the interval between the date of hospitalization and the date of re
lease representing the duration of the disorder Table 1 tahen from Kra-
mer (1957, p S2S) depicts the prevalence of the hvpothetical disorder m
each community on Januarv 1 of each 'ear assuming that (a) 100 peop
are cured annually in commumtv (b) in communitv B 10 percent ot
each cohort of 1000 new cases of those who are still disturbed at me
gmning of each year are cured during the following vean an (c) m ea
cohort of 2000 new cases m community C, -50 percent of i wo* s 1

tnrbed at the beginning of each vear are cured during o T' =* .

It can be seen that although the annual incidence o psv ^

eal in communities A and B, the prevalence rates on Jani ^

Tear begin to differ considerablv after the first .tauonarv at

^mple, in communitv A the prevalence rate - increase.

55 °0 patients whereas the prevalence rate in communi ot her

steadily to 6859 cases by January 1, 1950 In community U on

Corj

Table 1. Illustration of Ways Three Ilvpothetical Van

tions Des clop in Three Different ^ of Diasse (frcra

ous Assumptions of Incidence an

Kramer, 1967)

^ cf w hidi ocron 03

^umty A Assumptions. 1000 new cues ® ^y ire cured a oA

January . of

cohort of »uch new cases. Tn P

cases on January 1, 1^9 c~-a.f:«5 tear

Pauenu u. on

T55 lMi i 9 E Bss w * * 0 * 3 _ —-—55 too

9» ™ ™ ® ^ M ^

- % S & 25 2 S s

1^0

1941

1942

1943

1944
19(5
1915
1947
1943

1000 900

1000

S s s 5 S
- -= S s s

1000

1000

JO oo

Community B Assumptions 1000 new cases annually each of which occurs on
January 1 of specified year, 10% of those ill at the beginning of each
}ear are cured during that year The prevalence count will stabilize
at 10 000 cases on January 1, 2007

Cohort of Patients m Hospital on January 1 of Specified Year

Year

1940 1941

1942

1943

1944

1945

1946

1947

1948

1949

1950

1940

1000 900

810

729

656

590

531

478

430

387

348

1941

1000

900

810

729

650

590

531

478

430

387

1942

1000

900

810

729

656

590

531

478

430

1943

1000

900

810

729

656

590

531

478

1944

1000

900

900

810

729

656

590

531

1945

1000

900

810

729

656

590

1946

1000

900

810

729

656

1947

1000

900

810

729

1948

1000

900

810

19-49

1000

900

1950

1000

Total

1000 1900

2710

3439

4095

4685

5216

5694

6124

6511

6859

Community B Assumptions 1000 new cases annually each of

which

occurs on

January 1 of specified year 40% of those ill at the beginning of eacn

year are cured during that year The prevalence count will stabilize at

5000 cases on January 1

. 1956

Cohort of

Patients in

Hospital on

January 1 of Specified Year

Year

1940 1941

1942

1943

1944

1945

1946

1947

1948

1949

1950

1940

2000 1200

720

432

259

155

93

56

34

20

12

1941

2000

1200

720

432

259

155

93

56

34

20

1942

2000

1200

720

432

259

155

93

56

34

1943

2000

1200

720

432

259

155

93

56

1944

2000

1200

720

432

259

155

93

1945

2000

1200

720

432

259

155

1946

2000

1200

720

432

259

1947

2000

1200

720

432

1948

2000

1200

720

1949

2000

1200

1950

2000

Total

2000 3200 3920

i 4352

4611

4766

4859

4915

4949

4969

4981

hand, where the incidence rate is 2000 per 100,000, double that of com
muni ties A and B, the prevalence figure reaches 4981 cases per 100,000
by 1950, the lowest m all three communities This example clearly shows
that although the prevalence of a disorder may differ among commum
ties, one cannot infer that the community with the highest prevalence will
also have the highest incidence In this example the community having
the highest incidence actually showed the lowest prevalence because
prevalence is a function of both the incidence of the disorder and its du
ration

EPIDEMIOLOGY / 427

To summarize, a higher prevalence rate in disease A than in disease B
can be accounted for in a number of ways. First, the diseases can occur
with equal incidence, but disease A can be of longer duration than dis-
ease B. Second, disease A may have a lower incidence but a dispropor-
tionately higher duration than disease B. Finally, disease A can have both
a higher incidence and can be equal, slightly shorter, or of longer dura-
tion than disease B.

The purpose of epidemiological studies of mental disorders is to IS "
cover relationships that determine the factors leading to mental isor cr.
These associations are uncovered by determining the rate at iv 1 lS0 ^
ders develop in various population groups and in various su segmen s
these populations, and the differential duration of the disorder in *
ed individuals. Data of this kind suggest possible etiologica re a 1
that must then be more firmly established through detai e
perimental studies. , . .

Although Roen (1971) dotes the Dunham

°gy m 1949, a classic study was reported in 193 > Faris an d

(1939) and two other studies appeared in the ■ ^ mcn .

Dunham study was concerned with the differen t major finding

tal disorders in different areas of a , ^r dty . ( l h! Xlk A .o n ’pi°ien. n t»i.
°f this study was that mental disorder rates a moves from the

dence, with prevalence rates decreasing regular ) as o ^ disorder

renter of the city to its periphery. Furthermore, spe nJ in ,i, c large
"ere found to be heavily concentrated in particular £ h)p0 ,i lc5 es

"than area, a finding that led to the advanoemen „[ para-

concerning their etiology. For example, the hew d(y sugs ested to
noid schizophrenia in the rooming house distnc . soc j 3 l isolation an
fans and Dunham that the disorder is caused “> , h e Jiving ar-

cealdown in communication patterns iat c

cangement of the rooming house. . in the 19-f Os "' cr c r

The two psychiatric epidemiology studies - (r j c disturbance in

'pled primarily to assessing the magnitude o P l0 variables sue >
9ncn locale, but eadi analyzed its data ini 1 ixniVaii. Tict.'C. a

**• race, and age. The first to appear in P n ()on e in Baitin' ’’
^>°pcc (1911; 1942a; 1912b; 1912c) "? 5 * lion s and agcnciOJJ
Maryland in 1936 of tile files of existing ,ns ‘ ]cncc figures for l 1 *

‘ng 3337 active cases. Beyond reporting P ' rate "an "9.

-W investigators reported that the mental < *». anJ

than for females and for negroes than .for ' 3r lo torrels-c

^ a,ts - conduct disorders, and mental deficient .

'crs^ly with family income.

The

. bad to

tlie earl”

- - / , . ...,dy dating bac,L ” iy near

-• second psychiatric epidemiology ^■illiarown i.

! 9, °' "as done by Roth and Luton (19*3 > ^ the «*»“"

^villc Tennrswv Its nrimar>' P l,r P° <c

title of

428 / research tn community psychology

the mental health problem in a representative rural county by identifying
the prevalence of mental illness and mental adjustment In addition, it
was hoped that etiological factors, especially those peculiar to life in a ru
ral area, might be uncovered Case referrals were received from nurses,
physicians, teachers, and the like, and a survey was done of an unbiased
sample of the total population The data were analyzed with respect to
the distribution of cases by age and race
In the early 1950s the Leightons and co-workers (Leighton, Leighton,
and Armstrong 1964) began a long range, more complex epidemiologi
cal study than had been seen up to that time in psychiatry This was done
m Stirling County, Nova Scotia, where m addition to attempting to estab
lishing prevalence rates for various types of emotional disorder, and to
determining how much professional psychiatric care would be required
by the population, the study was used to test the hypothesis that more
mental health problems would be found in a ‘ disintegrated community’
than in one manifesting greater integration The integrative capacity of a
given community was seen to depend on its ability to provide " (a) per-
petuation of itself through recruitment and indoctrination of new mem
bers (b) subsistence, (c) protection against dangers, (d) promotion of
harmony, and control of hostility, (e) division of labor, and (f) the func
tiomng of leaders and followers (Leighton, Leighton, and Armstrong,
1964, p 168) Prevalence figures were compared between communities
defined as disintegrated and others defined as integrated, and the Leigh
tons report that more individuals from disintegrated communities were
classified as cases,’ a greater number of different kinds of symptoms
were found among these individuals and their impairment was greater
than that of individuals coming from integrated communities In fact, the
integration level of the community in which the individual lived was
found to be more strongly related to mental health than were factors such
as sex age, or occupational status

Another epidemiological study of the 1950s that was done to test a
particular hypothesis was conducted by Hollingshead and Redlich
(1958) The hypothesis advanced by these authors was that mental ill
ness in a given population was related to social class status Furthermore,
they were interested in the type of treatment received for mental illness as
a function of class position This study, earned out in New Haven, Con
necticut, surveyed all of the local treatment agencies extracting detailed
information from clinical psychiatric records Prevalence figures were de
termined for psychiatric cases falling into various social classes The find
ings of this study were in keeping with the investigators’ hypotheses the
prevalence of psychiatric patients in the lower social classes was consider
ably higher than in the higher social classes These relationships continue
to hold up even when variables such as age, sex, race, religion, and mari

EPIDEMIOLOGY / 429

tal status were controlled. Further analyses to determine whether types of
mental illness distributed themselves differentially among the social class-
es revealed that neurotic disorders were more prevalent among the higher
social classes while psychotic disorders were more prevalent in the lower
social classes. Finally, Hollingshead and Redlich examined the relation-
ship between social class and the types of treatment applied. Their find-
ings were that psychotherapy, and particularly insight therapies, were
applied disproportionately more frequently to neurotic patients of the high-
er social classes who were being treated by private practitioners than to
members of the lower classes, who tended to be treated in state hospitals

with organic therapies. ,

Perhaps the most elaborate of the psychiatric epidemio ogy s u les
has been done to date was carried out in New York C.ty and has come to
be known as the Midtown Manhattan Study (Srole ar ^ d
chael. Opler, and Rennie, 1962) . The investors in thd .study Bgu&d
their work as innovative among pscylnatnc

tsvo counts. First in addition as psychiatric cases.

S ™ -o' =^h asseslg the rn ^ M thene

who were untreated. To achteve dm population. Ex-

adults representing a cross-sectiona P b j ects an j, 0 n the basis

tensive home interviews were done wi ^ menta ] health status of

of the interview data, ratings were f hJ tu( jy involved the

each individual. The second innosa .ve fca^ onhts^J^ ^ of

investigators' attempt to relate i th« „ s epidemiological studies.

demographic factors than was k P Midtown study concerning the

The basic prevalence findings were tha t approximately 60

mental health status of the unffea ‘ ZJ sub clinical symptomatology,
percent of the adults surveye m syro p to m free, and that the re-

that another 20 percent were found .to b >™P since n0 sim!Iar stud-
maining 20 percent were rather seriously ^ to compare

ies had been done in other ur a Man hattan with those of other ur-
these prevalence figures for m, drown Manhat.

ban areas. classified with respect to age an so-

When the untreated group vv div jd U als were found among

cioeconomic status, more ™P a ‘ re< * * ^ong the younger -and high-
older and lower socioeconomic free individuals wer

er economic groups. Conversely ewe^y^.^ ^ than among .he

found among the older and These findings replicate

sex-related mental health d.fferences

EPIDEMIOLOGY / 431

talus V,cit r type N immigrants were far less acute than they were for type O
tal illncr ants - Indeed, a significantly higher percentage of generation I sub-
rvealctl t tv l 10 se backgrounds seemed to exemplify type O immigrants were
j] as impaired in comparison to those of generation I whose back-
al das n ^ s naore closely resembled type N immigrants. These findings led
, Mid town investigators to conclude that rejection of the hypothesis

the generation variable is significant for mental health ratings is un-
] id rrented. What they did conclude was that transplanation from one cul-
q. ral setting to another is not decisive per se, but that the degree of dif-
Vence between the setting from which the immigrant comes and that to
k/hich he goes is decisive. Thus, if generation I had a majority of type O
immigrants, high impairment rates would have been found in this group
as was originally hypothesized.

The findings of the many complex analyses carried out in the M.dtown
study have led to several important conclusions and have suggested many
hypotheses that should be put to test in more detailed studies The
vitally important finding has to do with the large percen age °
subjects found among the untreated group. Of the approximately 20 per
cent of the Mid.own sample regarded as seriously unpaired only 27 P=
cent had ever been patients during their lifetime. The renaming « Per
cent had never seen a psychotherapist, and of these a PP “^ter

percent appeared p^ble^WhaTthis points to is the very

vention in connection with their problem . ,,J,m U nity for seeking

large potential among untreated :"^‘ d “""XBnLg 1-
the care of mental health profession • characterized

portant implications for who were being

the mentally ill only on the b relatively few in number

treated, assuming that the : untreate F P c(mld nQt sigI1 ifi c antly affect
and that whatever thsir characten • Th< , Midtown findings indi-
generalizations drawn from a trea gr P- ana i ys es of their de-
bate that the untreated are not few in number. *nd gj* ^

mographic characteristics * n “““ Vj individuals who receive pro-
many important ways from those unpaired in

fessional treatment. although impairment rates increase

The Midtown study found that . Bj ? who had been pa-
with age, the rates of those among The^ P^^ ^ agc With respect
tients for an emotional proble although total patient rates

, te TJ°tha t although total patient rates

to socioeconomic status it was revea . a j e impairment frequencies

> the socioeconomic scale , P tQ be a co „.

. « socioeconomic sc ^ to be a co „.

increase as one^ b y *the < fur*h er finding that in dm impaired

decrease as one goes up <

tradiction here is clarified by the lurin upWard on the socio-

group the ever-patient »»»« of the impaired indmdualson

economic scale. This means that ve £j™° ome patients, whereas at the
the bottom of the socioeconomic

430 / research in community psychology

sample but that some differences were present with respect to religious
origin (the faith in which the respondent’s parents were reared) Along
this dimension, the mental health picture among Jews in the sample was
most favorable of all, with Protestants next, and Catholics manifesting
the most mental health problems Jews were found to be heavily concen
trated in the subclinical, mild to moderate mental health category
Another demographic variable that was carefully considered m the
Midtown Manhattan study was the period of time each subject’s; family
had been in the United States Subjects were classified as generatfon I if
they themselves were foreign born American born children of immi
grants were m Generation II The grandchildren of immigrants wore in
generation III and generation IV included all subjects who had four
American born grandparents It was hypothesized that generation IV
subjects, coming from families that were clearly "at home" in American
society would manifest the fewest mental health problems whereas gten
eration I subjects, who were uprooted from one society and transplanted
to a new one to which they had to acculturate, would experience coil
siderably more stress and would thereby suffer more mental health prob\
lems Essentially it was expected that the mental health picture would be
progressively more favorable as one moved from generation group I to
IV The findings with respect to this variable tended in the hypothesized
direction with significant «differences being found between the two ex
treme groups generations I and IV However, when controls for age and
socioeconomic status were instituted, the original differences were practi
cally eliminated entirely

Rather than reject the hypothesis regarding the generation variable,
the Midtown investigators probed more deeply into the data in search of
still another mitigating variable that might account lor the failure to find
differences They reasoned that there were essentially two types of mum
grants among generation II subjects One group had immigrant parents
who arrived in this country during the period from 1901 to 1914, histon
cally a turbulent time when the immigration flow was enormous and con
siderable political disorganization prevailed in the cities receiving
immigrants These conditions compounded adjustment problems for these
immigrants When free immigration was eliminated in the United States af
ter the congressional acts of 1921 and 1924, a marked change took place
m the makeup of the immigrant coming to this country Among the pre
1921 immigrants (type O) the majority were poorly educated farm la
borers village dwellers and predominantly men During the post 1921
period the new immigrants (type N) were more likely to be profession
als semiprofessionals or white collar workers, and they did not enter
into urban areas strained by the turmoil of rapid expansion This was
also true for generation I subjects who were themselves immigrants It
was hypothesized by the Midtown investigators that the adaptation prob

EPIDEMIOLOGY / 431

lems for type N immigrants were far less acute than they were for type O
immigrants Indeed, a significantly higher percentage of generation I sub
jects whose backgrounds seemed to exemplify type O immigrants were
rated as impaired in comparison to those of generation I whose back
grounds more closely resembled type N immigrants These findings led
the Midtown investigators to conclude that rejection of the hypothesis
that the generation variable is significant for mental health ratings is un
warrented What they did conclude was that transplanation from one cul
tural setting to another is not decisive per se but that the degree of dif
ference between the setting from which the immigrant comes and that to
which he goes is decisive Thus, if generation I had a majority of type O
immigrants, high impairment rates would have been found in this group

as was originally hypothesized , _ , .

The findings of the many complex analyses carried out in the Mid own
study have led to several important conclusions and have suggested many
hypotheses that should be put to test in more detailed studies The first
vitally important finding has to do with the large percentage o im P ai
subjects found among the untreated group Of the approxima y pe
cent of the M.dtown sample regarded as seriously tmpa.red only 27 per
cent had ever been patterns durmg them life, .me The P

cent had never seen a psychotherapy and of these appro^matelyjg
percent appeared quite ready to accept some sor ° P ,

vention tn connect, on wtth them problems What this points
large potential among untreated indivi ua s this findin g has im

the care of mental health profession s u ^ have characterized

portant implications for resea ^ rS J ho5e indiv ^ d uals who were bemg
the mentally ill only on the bast relatively few in number

treated assuming that the : unmea * f cou]d not slgm ficantly affect
and that whatever them characte y ^ Mjdtown findings tndt

generalizations drawn from a trea & P^ ^ analy5es o£ the , r de-
cate that the untreated are not few are indeed| different in

mographic characteristics indica d ^ dividuals who receive pro

many important ways from thos p

fessional treatment although impairment rates increase

The M.dtown study found that a S ^ who had been pa

with age the rates of those a ™° n sj d (o ^crease w ,th age With respect
tients for an emotional prob although total patient rates

to socioeconomic status it was revea xmpairment frequencies

decrease as one goes up the socioecono What seems to be a con

increase as one goes up the soc, ° eco "° findmg that in the impaired

tradiction here is clarified by ie ^ upward on the socio-

group the ever patient rates few of the impaired mdn .duals on
economic scale Tins means th . . ome patients, whereas at the

the bottom of the socioeconomic scale become P

432 / research in community psychology

top of the scale a relatively small number of impaired cases contribute a
large number of patients It is also found that among the patient group
one is more likely to see younger adults (in the age range of 20 to 39)
from the upper or middle socioeconomic scales who are American bom
The untreated group is more likely to contain older adults (ages 40 to
59) from the lower rungs of the socioeconomic scale and of foreign birth
These discrepancies between the two groups may in part be a function of
a lack of awareness of professional resources for dealing with emotional
problems The Midtown investigators also attribute these discrepancies to
a selection process initiated by professionals on the basis of assumptions
about prognosis treatability or sociocultural congeniality

The findings of the Midtown study have led its investigators to offer
hypotheses regarding vulnerability to emotional disorder One emphasizes
the significance of socioeconomic status The normal family unit is seen
to operate in such a way as to smooth over potentially disruptive forces
and to maintain a psychological and sociological balance that enhances
its members capacity to deal with unbalancing crises The low socioecon
omic status family has very likely experienced prolonged economic hard
ship which makes it difficult for the family unit to react smoothly when
confronted by crises such as disability among the parents unemployment
or death Such a unit is seen to be brittle and disintegrative A wide
range of wealth within a given community accentuates the deprivations of
the low socioeconomic family and invariably affects a child s view of the
adequacy of his parents damages a father s sense of self respect and re
suits in a great deal of frustration for the father which is converted into
aggression against the wife and children All of this adds to the problems
besetting a family unit of this kind Thus the Midtown investigators hy
pothesized that the finding that people growing up in families of low so-
cioeconomic status have maximum vulnerability to mental disorder can
be explained on the basis that they are handicapped with respect to their
personality resources their social skills and the lack of an example of a
cohesive family unit Furthermore they have been damaged by the com
bined effects of growing up in poverty and of suffering the stigma of the
community that in many respects has rejected them

The Midtown investigators hypothesized further that the same familial
factors that create vulnerability m those at low socioeconomic levels can
produce vulnerability in the socioeconomically advantaged The combi
nation of an inadequate personality weak social skills and a poor self
concept is seen to invariably predispose an individual whatever his social
ongins to emotional disorder when the pressures of unsettling events are
encountered Most significant as a general class of such events would be
a necessity to change one s social role

ECOLOGY / 433

The immigrant is seen to be particularly vulnerable to emotional disor-
der because the aery nature of being an immigrant involves a wrench
from one type of role and cultural situation and the necessity to adapt to
a drastically different setting Here, however, the Midtown investigators
hypothesized that the extent of the necessary change, as reflected in the
degree of contrast between the native environment and that which is
adopted, has an important bearing on vulnerability

The Multown study is discussed in some detail because it is a good ex
ample of a complex epidemiological study whose findings yield important
information about the character of the community investigated, as well as
hypotheses concerning the etiology of mental disturbance It is precisely
for this reason that epidemiological research is of great significance for
the community psychology movement

ECOLOGY

The term ecology refers to the scientific study of the interaction between
the organism and its ennronment (Sells 1969) Its “
ture of the interaction of organisms and populations with '
environment, which supports, influences, and deterntmes th lm ts of
structure and function for the life that exists wtthtn « (Sdh ; 1969, P
15) Ecologic methods have been applied in bjotogy, “td out of emdl
and more recently in psychology Me ica eco ogy disease proc

■otology when researchers became ‘^stf of the study of the

esses could not be understood y zed thal m ad dmon to the

bacterial agent causing dl ^ W ^ J remI " onm e„iaI factors must pertain,
presence of this agent * vanmy o CommumcabIe disease came to be

if disease is to result (Gordon, ) ^ q{ an mfectl0 us agent a

viewed as resulting from the recipr

host, and an intricately complex en v ironmen r q£ blologlsts Hu

In the past, ecology has been P< concept to understanding

man ecology has involved «[> e ap P ‘ ca * , “ n ]t has been used principally by
certain aspects of human beliavi , lbe wa y human population

geographers and sociologists concern ^ resources, health, soaal,

groups are distributed as a funct

economic, and cultural patterns holoey has been a recent de

Emphasis on human ecology wit points out that in oper

velopment Barker (1965) , a soctal pycholo ^ .. P . ^ psychoIoglst has
ating from the traditional experim on ditions under which data are
exercised considerable control over the o£ tbe subject, and

received by the human subject t e in t he psychologist has in

the output that the subject produces In

434 / research in community psychology

jected himself into the phenomena he is attempting to understand by vir
tue of his role as an operator The advantage this role provides is that
it allows the psychologist to focus intensively on segments of behavior
and processes that are of particular interest to him Research of this type
is commonly carried out within the laboratory according to the expen
mental method and not uncommonly is seen to exclude the clinical meth
ods

Because psychological researchers have mainly been concerned with
isolated fragments of the environment, Barker (1969) suggests it is not
surprising that little psychological study has been done of the global envi
ronment and the force it exerts on behavior In fact, in large measure re
searchers have looked on man s environment as * an unstructured, prob
abilistic and largely passive arena within which man behaves according to
the programming he carries about inside him ’ (Barker, 1969, p 32) In
essence Barker feels that, as a science psychology has performed a circu
lar self validation concerning the environment Prevailing research
approaches have purposely fragmented the environment, studied it piece
meal and after considerable experience in dealing with it this way has as-
serted that no order exists within the environment and the natural setting
to be used as an element in the study of the organization of human be
havior For Barker this era began as soon as psychology established itself
as a laboratory science in which the psychologist became a surrogate of
the environment and the natural environment was ignored Thus psychol
ogy has learned a great deal about man s behavior under certain artificial
and highly controlled conditions but it knows very little about his behav
lor in the natural environment where the interplay between internal and
external factors is extraordinarily important

Since the hallmark of community psychology is that it takes serious
cognizance of the impact on man of his natural environment, the ecologi
cal approach supported by Barker is of fundamental importance Barker
stresses the interrelationship between psychological phenomena and the
environment in which they occur He points out that knowing about the
theory of electrical generators does not allow one to explain the function
ing of an internal combustion engine Similarly, traditional psychological
approaches cannot explain the functioning of taverns, school classes or
other settings found in mans natural life situation, and any theories
about these settings are unable to account for the behavior of the people
participating in them Concepts and theories different from traditional
ones must be used to characterize people and the settings that make up
their real world The distinction between the questions raised by poverty,
technology, population and those with which traditional psychological
science has been dealing is very basic Thus Barker calls for a radically
new research approach

ECOLOGY / 435

Kelly (1966), a psychologist closely associated with the community
psychology movement, has spoken forcefully for the necessity of assum
ing an ecological viewpoint toward mental health problems He regards
this viewpoint as being relevant in, at least three separate contexts One
type of problem requires analysis within a community of the relationship
between existing mental health services and other available services
From an ecological viewpoint any change in the operation of one service
unit in a system will have an effect on the operation of all other units
For example, when one local mental health facility shows a dramatic in
crease m admissions, it is very likely balanced by a decrease in a is-
sions to some other area facility, or by a change in social stress patterns
which produces more patients The second type of ecologica pro em in
volves the study of relationships between a setting s physica c larac ens
tics and individual behavior Thus population density, or t e up eava s
urban renewal programs may have profound effects on t e ives
area’s residents A third realm in which ecologica a PP*°f c es a , j
vant is the study of the relationship between individual behavior and the
immediate social environment Fundamental to t is approa .

tion that individual behavior is related to the social situationmwhichit
occurs, suggesting to Kelly the need to redefine the concept of pathology
For Kelly, behavior is

"not viewed as sick or welt but is defined as an d the indi

of reciprocal interaction between s P e *fc *°™L by any individual in a
vidual Adaptive behavior then can be p environments, and

restricted number of social settings or in a , „ (K n

can vary from time to time as well as from place to place (Ke

A major problem in conducting ec0 '?^ al n L ing i,mits on the stun
being m h,s natural environment and avoiding -mpo ^8 ^ what

uli that he experiences and the responses e puts it but when an in
units of behavior to observe As Barker ( F &f behavloI - f what are
vestigator does not impose his umts on tw ■ Barker and his co-work

its units? In attempting to deal wit 1 “ in spe cific settings One

ers started out by observing periods o t „ racUO n with her mother m
such setting involved a child Maud m an reccived 2 6 social inputs as
a drugstore During this interaction t e c

depicted in Figure I h resp0 nded to only abou *

Of the 26 inputs received by Maud n P s ,„dies by Barker and fel

third Other observations of human m particularly extreme in t us

low researchers indicate that Mau additionally schoo e m

respect Still such findings are dlsU!rb,nS hat on ly one half a colony of
ves.iga.or They may be likened to finding

436 / research m community psychology

rats is willing to run a maze, or that a subject returns a questionnaire with
only one half of the questions answered On the other hand, despite the
fact that Maud failed to respond to a large percentage of the inputs she
was receiving, her behavior in the drugstore was actually appropriate to
the setting She had her ice cream cone and enjoyed it, she did not read
the comics, she handled the Christmas cards only to a small degree, she
sat on the stool, she was not given the soda that she requested, her coat
was removed and later it was put back on, and she left the store in a gen-

Mother "We'll all go to the drugstore"

Mother "Not now, you're not having o comic now "
Mother "Leave things [Christmas cards] alone "
Mother "Come on now, get your coat off "

Mother "Maud, come back and sit down "

Mother Pushes Maud toward the stool
Mother "Now you sit here "

Mother "What do you want, Maud?"

Mother "Oh, you don't want a soda "

Mother "No, you don't get a soda "

Mother "What do you want 7 "

Mother ' You don't want a soda Besides you wouldn't
drink it if you had it"

Mother "Do you want a coke?"

Mother ' Do you want an ice cream cone?"

Mother "Do you want an ice cream cone?"

Clerk "What flavor, Maud?"

Clerk "Vanilla, that's the white one"

Clerk "Don't eat Fred's cone "

Mother "Come on Get your coat on, Maud "

Mother Refuses Maud's whispered request
Fred Snatches Maud's coat
Clerk ' Hi, Maud," as she ruffles Maud's hair
Mother "Come on "

Mother Pushes Maud toward her coat
Fred Asks Maud for gum (from gum machine)

Mother Urges children from store with words and
motions

Figure 1 Twenty six social inputs received by child in a drugstore situation (Barker,
1965)

ECOLOGY / 437

erally agreeable fashion If the entire episode is to be regarded as a test of
Maud’s drugstore behavior, it appears that she failed many of the specific
items but still passed the test

What this seems to point to is the fact that for understanding behavior
in a particular setting there is probably little point in attempting to dis
criminate m detailed fashion the small inputs directed toward controlling

behavior Instead, behavior seems to be responsive to major environmen
tal force units (Schoggen, 1963) defined as actions by an environmental
agent toward a recognizable end state for a person, the unity of which de
rives from its constancy of direction with respect to the person on whom
it bears While this environmental force unit may involve a variety of dis
Crete inputs, behavior seems responsive to the overall direction 0 1 e
intact environmental force unit rather than to its separate components An
other way of stating it is that long segments of behavior relate m ° re “
rectly to global environmental forces than do short segments o e iav
One of the problems m at.emp.mg to understand Maud s drug^ore be
havior on the basis of the 26 separate social inputs w i
rng was that by breaking the environmental system in ° ‘ he “ 1
system as a whole was destroyed and many o its sep P ' be

be viewed as apparently ineffective ^'^Xthe environment on

havior Furthermore, the psychological imp !e people interact

Maud included more than those inputs atm u a mother

,n g with her in the drugstore

and the clerk who was serving her, but > , te mporal ar

ers, equipment, the merchandise, the particular spaaal and te p

rangements, and by the rules of the We.*" ^total impact of
a variety of studies besides his own in ■ people who are involved

situations that influences behavior more ^ envJ ^ nment an d behavior ”
in the mutual causal relations be and sldewaIk5> mealtimes, and

Thus situations such as drugstores, behavl or even when they in

arithmetic lessons have different e

volve the same people researchers to study individuals

This type of insight has led eco ogi ' , m con ductmg this kind of

in specific behavioral settings One app , which behavioral set

research involves identifying some dimensi and then

tings vary although they may 5elongs Barker and Gump

to examine behavior m the two*' ere " 0 f varying sire Their ob

(1964) have been interested in schoo P property of settings that

irvations led them to believe that • of human compo-

has important behavioral consequent lbat a sandlot baseball game

nents within them They note, for «a P - dl(rcren[ requirements on
in which there are four to a side ‘ m P°* s on a s ,de Who the plajers
the players than a game basing nine players

438 / research in community psychology

are is immaterial Once one engages m a game in which there are four on
a team he enjoys certain privileges, such as batting more frequently, and
suffers certain special burdens, such as covering a wider area of the field
Barker and Gump (1964) have done extensive comparisons of a van
ety of student behaviors m large and small high schools Total enrollment
m the schools studied ranged from 35 to 2287 In this research the first
task was to arrive at an estimate of the total number of parts contained
by a given school In attempting to partition an entity such as a school,
the first thing that comes to mind are its various classes However, these
are not the only places in the school inhabited by students Many interac
tions take place in the hall, in assemblies, in administrative offices, in the
shower room, and the like The ecological units that represent the parts
of a school setting having significance for directing human behavior have
been termed behavior settings by Barker and Gump Viewed as "organ
lzed assemblies of behavior episodes, physical objects, spaces, and dura
tions,’ behavior settings are seen to have marked coercive power over m
dividual behavior For example, students do not ordinarily dance in the
chemistry laboratory, nor do they conduct chemistry experiments at a
prom

Barker and Gump point out that many earlier studies have helped to
provide an understanding of behavior settings One resulting part of the
theory of behavior settings holds that a setting is a homeostatic system
with controls that maintain the setting intact and operating at a stable
functional level under widely varying conditions’ (Barker and Gump,
1964, p 19) The forces making for stability within a setting originate in
a variety of sources Some arise from the setting itself, in the classroom,
there is a time schedule, a set of rules, and the physical arrangement of
the room Other controls derive from the relationship of the setting to the
ttV&ataan TVre Wine -stViwA, ior example, runs according to a
fixed schedule and a set of regulations that imposes requirements on indi
vidual classes Still other controls derive from those individuals who in
habit the setting and from other factors internal to the setting itself, ex
am pies of such interior controls are the textbooks used in a class, and the
students’ level of maturity

A second part of the theory of behavior settings holds that the behav
ior engaged in within the setting must conform to a set of constraints nn
posed on it by the rules and characteristics of the particular setting In
this sense the form of the setting may be compared to a chair, and behav
ior may be compared to the person who would sit in the chair To a great
extent, the individual must assume a form that is compatible with that
provided by the chair he is sitting in

A third part of the theory holds that behavior settings, to maintain
themselves in operation, have an ideally optimal number of internal ele

ECOLOGY / 439

ments Tor example, a baseball game requires approximately 20 partici
pants, 18 placers and 2 officials Within limits, the setting can continue to
maintain itself mth fence internal elements but to the degree that it does
so, certain consequences follow for the individuals providing the av
■oral input Tno of these are that (1) the strength of the forces acting
on the participants increases, and (2) the range an irection o le
forces that act on participants increases

The final aspect of the theory of behavior settings is that the setting
provides the opportunity for its inhabitants to erive many sai
and to satisfy many personal motives Furthermore, the d.ffaen nhab
ants of the same setting may have different needs that are me w thin .
Thus the boy who pitches in a baseball game satisfies « » ^

physical neetis, Ins mother watching in the bleacher, receives a different
set of satisfactions, and lus coach is satis e ms ^ ^ achieV ing satisfac
to this aspect, ,s the inhabitant s obligati ^ continue [0 ^ possible
tions, also help maintain the setting s when a threat t0 the mam

later for lnm to achieve satisfactions ^ ([> ^ strong enoug h to

tenance of the stability of the setting I* of sat , s factions, the force
threaten its occupants with a loss of

to maintain the setting grows settings and a previously

On the basis of the theory regard g and G um p determined

worked out system for identifying t em students in the schools that
the variety of behavior settings avai a e ^ j^gest school with four
they studied Surprisingly, a com P ar * so " schoo l had 20 times as

small schools revealed that althoug behavior settings and only

many students it had only 5 times as ueee sts that the small school
1 4 times as many varieties of settings students but not necessarily with
is small only with respect to num er ’ ® c cant parts
repect to the number of its behaviora ^ the differentiation of large

The findings with respect to the ex t0 an in terest in the de

and small schools led Barker and Gump ated school activities

gree to which students in such sc o schoo]s reV eal that on t e av

Comparisons of students in sma an ® approximately tw ic ®
erage! students in the small **°*?%* m th e large schools Further
many extracurricular activities as h more likely to hoi po 1

more, students of small schools and these positions were

of responsibility within their behavior settings ^ ^ students oflarge
occupied in more varieties of settI ”^ am ong students of large sc
schools Greater variation was ou cipa ted ,Wivrd

the number of settings in which t ey p degr ee of satisfactio

Barker and Gump also tried to assess^ * ^ a function of them

by students from the activities they sma u schools as comp

school size It was found that jun.ors

440 / research in community psychology

large schools felt they had achieved greater satisfactions from a growing
sense of competence a feeling of being challenged, a sense of doing
something important a feeling of being truly involved in group activities,
and of achieving the values of their culture Juniors in large schools were
more likely to report that their satisfactions came through vicarious en
joyments from being affiliated with large organizations, from learning
about the people in the school and the affairs of the school, and from
gaining points because they participate Students in small schools also re
ported that they were more readily attracted and even pressured to taking
part in nonclass behavior settings than were students m large schools
Their response to this indicated that they felt more involved and took on
greater responsibility than did large school students

Comparisons were also made of the community involvement of stu
dents of small and large high schools It was found that community activ
lties were more frequent for students who came from small schools and
small towns than for those in large schools in urban areas These differ
ences were more prominent for boys than for girls but in general, there
seemed to be a harmony between the school and the community Just as
the small school provided more opportunity for the student to engage in
responsible important positions so did the small community Such op
portumties were less frequent in the cities

Studies were made by Barker and Gump of differences m school struc
ture as a function of school size It was found that about the same pro-
portion of the behavior settings of schools of all sizes are devoted to the
formal educational enterprise However fewer varieties of formal educa
tional opportunities were found in small schools and the number of dif
ferent classes dealing with a particular subject was smaller in the small
schools Despite this it was found that large school students participated
m fewer varieties of classes than did small school students Students spe
cializing in music were studied in some detail with the finding that those
m small schools acquired a broader experience within the subject than
did those in large schools although more large school students special
ized in music

Barker and Gump sum up their findings by urging that further re
search be done to determine the degree to which the relationships they
found between school size and student behavior are inevitable Hopeful
ly studies of this kind might begin to indicate the optimal school size for
achieving certain desired goals Good empirical answers to such questions
would provide a basis for redesigning the structure of schools

Another significant line of research carried out within the ecological
framework was conducted by Kelly (1969) in keeping with some of his
notions about adaptation as a function of the setting Since Kelly s work
is described m a previous chapter, it is summarized very briefly here The

ECOLOGY / 441

major premise behind Kelly’s research is that functional variations be
tween environments produce differences in the development and control
of norms within such settings, and also in the requirements for adaptation
to those settings Thus a given coping style may be adaptive in one setting
and entirely maladaptive in another To the extent that this notion is val
id, Kelly believes it is important to specify the environmental conditions

related to adapting and failing to adapt to various settings

Kelly chose to compare the environments of two high schools varying
with respect to student turnover rate One of the schools he studied ha
an annual turnover rate of 42 percent whereas the turnover rate in t e
other was only 10 percent The high turnover school was characterized as
having a fluid, environment, and the one with low turnover was con
sidered to have a constant environment It was hypothesized that living
styles necessary for adaptation to each setting would 1 er l K:tl “
Kelly predicted that in the fluid environment the social grouping
be relatively unstable and that there would be many ases or ® , ,

tification Also, in the rap.dly changing environment, .1 was , expected that

personal development would be highly value y . ant j

stant environment the social status changes won d be relatively rare^and

the primary goal of the community m “^ r J°“ 0 dcvd 0ne s sen se of
himself within the status hierarchy rather t a l regulating

worth m tins setting would be determined more by die : external regu. g

units of the society rather than by one s hdd tha[ people who

A specific hypothesis that was tested roore y effectlve ly in the fluid

are high m exploratory behavior woi pe el those low on

environment than in the constant environm as t ff e more effective

exploratory behavior were expected to e re S

copers in the constant environment male high schoolers who

Among Kelly s early findings is the act j tQ fj e regarded as de
are high in exploratory behavior are more ent school than are high
viant by the faculty of a constant envir jehool environment In

exploratory males rated by faculty in a fl ul d and constant en

addition subjective comparisons o sc oo ^ students in a flmci en

vironments indicated that dress is more v an often found in the fluid

vironment, groupings of up to 12 stu entS * t an d considerably more
envtronmenf than tn the constant envtcomnem,^^ ^ the „ u ,d
uniformity of dress exists m the constan follow two distinct pat

one Communication in the fluid school ;^ v ocalization or no obvious
terns — either intense, dramatic gesturm 1 on i y a single style o com

communication at all In the constant « ho “ °" ^ omnie „tary " Obw«
mumcation ts observed-a generally ^ * of 3 0 .0 110 ennane«

ttons m the fiu.d env.ronment revealed ^ by both students

into the principal s office during a

442 / research in community psychology

and teachers as compared to a range of only 1 to 15 entrances per three
minute period in a constant environment In the hallways of the fluid
environment noise level tended to be higher than m the constant environ
ment, and much conversation took place between group members, de
spite the presence of student and faculty monitors Interviews with students
revealed that newcomers to the constant environment were not wel
corned whereas in the fluid setting a formal welcoming committee for
newcomers was set up with varying membership

Another example of an ecological approach to understanding behavior
in the school setting is the subjective observational study of the kinder
gartner described by Sarason (1971) Sarason was interested in whether
he could learn something of the culture of the school by observing kin
dergarten children He approached the task simply by stationing himself
in different parts of the school on random occasions to determine how
frequently he would encounter a kindergartner in each location A1
though Sarason was not systematic with respect either to the parts of the
school studied or the recording of his observations, he did come away
with some interesting impressions

First one place he never saw a kindergarten child was the lavatory,
because in the school he studied as is true in many schools, each kinder
garten room had its own toilet facilities A second impression was that
the likelihood of seeing a pupil from the kindergarten decreased as dis
tance from his room increased Finally, the higher the pupil s grade the
more likely he would be seen m different places in the school The over
all impression was that kmdergartners are rarely allowed out of their
classroom and they therefore see very little of their physical surround
ings in the school

These impressions prompted Sarason to question school personnel
about why kmdergartners seem so restricted in their range of contact with
the diverse school parts Responses to these questions implied, first that this
restriction is so deeply rooted in school tradition that it has been rarely re
fleeted on When reflection was provoked respondents tended to indicate
that kmdergartners are different from older children m such a way that
they require constant surveillance Another aspect of this view was that
the kindergarten is less a part of the school than it is a place to prepare
the child for school A further assumption underlying these practices was
that the kindergarten youngster might be easily led astray by the older
children

While he acknowledges some merit in these views of the kindergarten
pupil, Sarason also challenges them He points out that the school cul
ture s way of handling the kindergartner results in a self fulfilling prophe
cy The way the school experience is organized inevitably confirms the
assumption that the child s movements must be restricted If the opposite

ECOLOGY / 443

assumption were made (1 e , that the child should learn to get around on
his own) , the child s learning opportunities could undoubtedly be ar
ranged so that lie could quickly learn to get around the school building
independently and without any obvious signs of fear The reason for en
couraging this exploratory behavior is, Sarason feels that most children
are curious about their surroundings and their fellow occupants of the
school This curiosity could be used to foster motivation for learning and
there is no compelling reason to delay its satisfaction A strong argument
in favor of Season’s suggestion is that most children who are required to
repeat the early school grades are characterized as immature e |" ta ’ n ^
the manner in which the kindergarten child is typically dealt with does
little to foster the maturity necessary for later school success

The types of stud.es that have been undertaken from “.'“logical
viewpoint have very obvious relevance for community ' psyc ' &

promise to provide an understanding of settings t at t e co
chologist may want to alter or manipulate toward certain deuredends
The problem is that research in human ecology is truly • (Q ^ tta

the methods that must be employed in tins area ,,959) s

ditionally tra.ned psychologtst Furthermore - barker
the necessary concepts and theories basic people live in

must he grounded on empirical for fa

their own natural settings Barker makes

cilitatmg the acquisition of these data who wQuld study phe

First Barker points out that the P y . g the phenomena to occur
nomena in their natural state cann interes ted will occur

And since many of the phenomena in w 1C be necessary to accu

only infrequently, long periods of o serv * 1 This pro blem is actually
mulate sufficient instances of these p en0 example, those who would
similar to many that face other sciences periods simply waiting

study earthquakes or bird migrations s] pe $ tJ]e phenomenon’s infre

for the phenomena to occur For sue sc ye f ea ture but, instead as
quent occurrence is not looked on as a _ ^ jn w hich these saen

an attribute that simply must be acce P , accumulating as much o
tists facilitate the study of a phenomen king lt generally available

servational data as possible about 11 a " y esta blish an eco behavioral
within some archive Barker ‘ “ This would require the

science, therefore data archives mus co u e ct, presene, an re

psychologist to learn a great deal a o ^

identifies as "Vons “since the «olop. cal

trieve these data /

A second need Barker identifies as ^ stations Since
havioral science is the establis imen ^ r.h ^nomena that

scientist is not an input »

cannot work m his own laboratory

source into the p-

d stauons d|CSf he

ihenomena .hat h' ^ ^

must do his business

444 / research in community psychology

phenomena are to be found Thus field stations, such as the Woods Holes
and Mount Wdsons of other sciences must be established and equipped
From his experience with such facilities, Barker specifies that the field
station s location should be identifiable with respect to the characteristics
of the larger context within which it is set, such as an inner city ghetto, a
rural community, or an industrial plant Within the locale where they
would work investigators should apply no constraints of their own Ideal
ly, they must have access to a setting without actually interfering with the
setting s function This limits some of the studies that might be done and
some of the techniques that might be applied Kelly (1969) questions
whether an observer can be entirely unobtrusive with respect to the phe
nomena he is observing in the natural setting Certainly this issue will re
quire considerable empirical study and, perhaps the development of new
methodological techniques

A third important need for an eco behavioral science identified by
Barker is the development of new data analysis techniques for dealing
with naturalistic phenomena Traditionally trained psychologists are not
equipped to deal with such phenomena Their natural tendency is to ap-
ply statistical techniques developed for use with laboratory problems,
which have the effect of destroying the naturalistic phenomena being in
vestigated Barker feels that the data reduction methods used m quantita
tive botany demography, geography, physiology, and economics may be
more appropriate for the eco behavioral scientist and should now be
studied by psychologists

GENERAL SYSTEMS THEORY

The general systems approach to studying organizational structures seems
particularly relevant to community psychology because it is concerned
with interrelationships between components within a particular system
and the interrelationships of the system with related systems von Berta
lanffy (1968) a biologist is generally credited with being the foremost
spokesman for general systems theory, having developed it as a means of
better understanding the functioning of living organisms Roen (1971)
points out that approaching mental health problems from the viewpoint
of general systems theory seems particularly valuable because the mental
health area is concerned with the general environmental context basic to
community problems The other advantage offered by general systems
theory to community psychology is that the approach encourages think
ing in terms of interdisciplinary relationships instead of holding to the
inevitably narrow viewpoint of a single specialty
■Within general systems theory, various specialized approaches have

GENERAL SYSTEMS THEORY / 445

been worked out to understand phenomena m specific social contexts
These include cybernetics, information theory, decision theory, and game
theory Cybernetics, regarded by \on Bertalanffy as the foremost of the
modern mechanistic systems sciences, is conceptually a relatively simple
approach Minimally, the cybernetic system requires a receptor that ac
cepts stimuli or information a center" that in some way reacts to t e
message received, and an "effector 1 that reacts to the stimulus and
makes a response In addition, in the cybernetics system a ee ac
mechanism monitors responses to the receptor and shapes su sequent ac
tion of the system to obtain a desired result In this way t e system is n
simply a passive receiver of information and a mec anistic reac ° r
regulate itself to some degree and thereby alter t e nature o 1
tion with stimuli The heating thermostat is a simple examp
netic system The thermometer ,n the theimosta. « the re«pmr and the
output is the heat produced by the heating system oo pe
suiting from the operation of the heating system is fed b f " I
tor, and the subsequent system activation depenc s on ] 10W ever,

ting von Bertalanffy points out that the Z ZZn

a closed model with respect to exch ^”^J informatlon from the envi
ment It is self regulating hut can only re rts are continually

ronment, unlike living systems whose co P ^ growthj develop-

destroyed and replaced in a process i as a special case of

ment, and differentiation Thus he views cybernetics as a pe

systems theory , e-ame theory are less special

Information theory, decision theory, a[lon theory ls somewhat

cases of systems theory than cybernetics . at in formation is a meas

related to cybernetics but stresses the no i an[ chan g e taking place

ureable quantity playing a basic role i ncerne d with the analysis of
in interacting systems Decision theory “ Game theory is relat

rational choices made within human org ana lyze the competition

ed to decision theory but uses m^matics^ or m0 re antagonists who
that takes place on a rational leve w

are striving for maximum gain an mm j t h e application o sys

Hutcheson and Krause (1969) "^ ey p0 ,nt out tts adian

terns analysis to the mental healt 1 hea lth services as well as is

tages as a rational aid to planning m systems approach is loo el
practical limitations For these authors al i 0 f the angles of a com

as a rational, well ordered way of « a T"”f, on gmen the constraints un
plex problem and arriving at an op i ^

der which one must operate systems analysis a PP roa ^ tfie

Hutcheson and Krause describe the sf^ (a) deeding on he

ing several interrelated goals These g ^ to systems ana ) -

objectives of the program that is to be J

446 / research in community psychology

designating the boundaries o£ the system to be studied and the subsystems
that make it up, (c) determining how the system changes and the factors
that cause that change, (d) building a model, either mathematical or
graphic taking into account all system elements, (e) manipulating the
model to test the effect of theoretical changes, (f) selecting the most de
sirable outcome given the general system objectives, and creating a pro
gram designed to reach this goal, and (g) considering time and cost van
ables as part of the design of the model to minimize costs and wasted
time so that an optimally practical and efficient program will result

Obviously systems analysis is most readily carried out in areas where
the relevant variables are easily defined Unfortunately, this is not true of
the mental health service field Usually it is possible to arrive at some
broadly defined program objectives that most agree on However, defin
ing the boundaries of a system and analyzing it into subsystems, the nec
essary second step in system analysis, may be very difficult to carry out
For this reason Hutcheson and Krause recommend that initial efforts to
apply systems analysis focus on relatively limited problem areas The
most significant limitation to place on research in this area would, for
these authors, be that of geography and topography Applying system
analysis techniques to the population of a small island, for example, hav
mg a relatively homogeneous population reduces the number of variables
encountered and limits the magnitude of the boundary drawing problem
Even in this instance however, Hutcheson and Krause warn against lim
iting the analysis to the mental health service sphere, or to exclusive
study of relationships between mental health or health and welfare sub
systems This is because many other variables such as unemployment
rates are often found to be closely related to the overall mental health
picture Thus all factors that have significant effects on the mental
health of a given area must be taken into consideration Another advan
tage of limiting systems analysis to a circumscribed region at the outset is
that intervention which may be suggested by the outcome of the analysis
is more easily instituted in the relatively simple society of the isolated
small town than in large, socially complex regions

Attempts to implement systems analysis techniques in the mental
health field are understandably rare despite their seemingly high rele
vance for community psychology Undoubtedly, considerably more effort
will have to be devoted to the basic problem of defining the subunits of
relevant social systems before the application of systems analysis will be
feasible In many respects this problem is similar to the one faced by the
ecologist who must detect the relevant units of behavior in the natural en
vironment as a first step in understanding the interplay of environmental
forces

EVALUATIVE RESEARCH / 4^7

EVALUATIVE RESEARCH

It would seem altogether reasonable that any new procedure, whether
medical or psychological, should be evaluated objectively before it he
comes widely used Perhaps surprisingly, this has rarely been true ar
stairs (1967, p 46) points out

‘■One thing is quite dear objective evaluations of the eiecliveness of
new procedures have seldom, if ever, preceded their gaining cHrrcnty '
psychiatric practice But evaluation of some sort has taken place man,
other practitioners have learned about the innovations and have udg ed
them worthy of imitation The agents of persuasion were, 1 suggest,

example, assertion , and dramatic illustration

Cars, airs also po.nts out that profess, onal eva^a'crs vvrth formal trarmng
in relevant research areas, inev.tably regard the ^ m.

ferent. more objecuve light than does the mnovator who creates P

gram and attempts to evaluate it himself dlstinKU1 sh between two

MacMahon, Pugll, and Hutchison ( > f accom pl,shment

types of evaluatory studtes The firs, cal d > ; procedl f re l£ ear

ts a test of the hypothesis that a par tic P.^ effects Although this
ried out successfully, has measurab . ^ most desirable it is not

type of evaluation would seem at face va on suc h studies are

particularly common The most importan ^ € g cct relationships is
few m number is that establishing true ca , , MacMahon et al , is
difficult The second type of evaluation researchers are not at

called evaluation of technique In t iese ^ b u t rather to deter
tempting to establish cause and e ect re to some standard

mine whether a given technique is c te common

for how it should be done These stu should precede eva ua

Logically, studies evaluating accomp produce beneficial resu ts

. \ is tpr.hnjque tans 10 F . Once

Logically, studies evaiu«u». 6 — - produce oencu^* —

tions of technique, since if a tec niqu ^, en followed reliably nee

there is little point m establishing t ia OW ever, continued studies eva

the value of the technique is established ho-e pI M «

uating the application of the technique immunity acceptance* is no
Mahon et al are careful to point out pllS hment They state
substitute for objective evaluations o a i ua tion and their pur

“ Before leaving the subject of Cloned, if only to be du

poses, there is one concept which shou,i ■ community accepl °"“

Lse'd This is the idea . U

are, ipso facto, beneficial T ^ acceptance of

evident It is demonstrated currently by

4.48 / research tn community psychology

nostrums, and historically by waves of enthusiasm that have been gener
ated by a variety of medical cults” ( MacMahon , Pugh , and Hutchison,
1969, p 53)

Research evaluating the effectiveness of treatment and training pro-
grams is quite familiar to many psychologists Thus the major retooling
effort that is necessary for the psychologist to engage in epidemiological,
ecological, and systems analysis approaches would not be required'in this
realm Nonetheless, research of this kind is not easily implemented, and
the community psychologist with a heavy investment in program develop-
ment is not always the best person to carry out program evaluation Cow
en (1967, p 442) has spoken cogently of this problem

"To place the matter in a slightly different perspective, the profession
al, if he’s to be effective, must believe in what he is doing and must be
invested in his everyday activities His role, understandably, does not
conform to a stereotype of detached objectivity that we have for the set
enlist To the extent that he serves simultaneously the roles of participa
tor and the evaluator of a given set of events, he must be regarded as a
biased observer for whom certain outcomes, whether consciously or oth-
erwise, may be mimical and unacceptable Though the observations of
the participating professional may represent one admissible source of
data, and, indeed, may constitute an especially fertile basis for generating
hypotheses to the extent that they are utilized as the prime vehicle for as
sessing the effectiveness of methods, we expose ourselves to systematic
error that will obstruct progress ’

Glidewell (1969) points to another significant problem m carrying out
evaluative research in community psychology Since the basic question in
evaluative studies has to do with whether or not an intervention has pro
duced the desired outcome untreated control groups are generally neces-
sary The problem with using control groups is that one is required to
withhold service from some research subjects as a means of assessing it
If the service is an old, accepted one albeit untested, such a methodolog
ical practice may be looked on as unfair to those needing it and, even
further, may be regarded as ethically questionable Similar problems are
encountered even with respect to new and relatively untried services The
practitioner is simply expected to do his best to help all who need it, and
outsiders are hard put to understand a procedure that purposely with
holds service

Herzog (1958) outlines a number of other issues that complicate the
process of carrying out evaluative research Although the fundamental
question of evaluative research can be stated fairly simply, that is, have a
giten group of individuals been helped by a particular program?, a closer

EVALUATIVE RESEARCH / 449

examination reveals that this is really an extraordinarily complex issue.
As Herzog (1958, p. 203) indicates: "Tins key question, however, is a
very unstable compound. Under examination it breaks down into a clus-
ter of questions: which ones have been helped? how much? how stable is
the help? was it really the treatment or something else that helped? who
says so? how do we know it is true?" Questions of this sort can be raised
about the efforts of a single practitioner. If measures of the work of many
practitioners or many different agencies are to be combined, several new
questions can be added. Did each individual or agency try to e p m t e
same way? Were the problems they were working with comparable in the
beginning? Did they work with people who were comparable with aspect
to their capacity to change? Were observed changes compara e m

^Igtsem that experts generally agree that a satisfactory evalua-
tion must deal with four types of issues. First, t ie ■P t ”’P° s (hat are to ^
tion must be made clear. Second, concerning i . changes

evaluated, the desired changes, and the ct to the

are to be brought about must be intimate . ^ bg reljabIe

methods for assessing change, the measures be d _

and valid, the points at which of the group

fied, the sample studied must be shown be demonstra bly due

one is concerned with, and any chang changes found must be

to the treatment that was applied, ma y, sbou ld be elaborated,

demonstrated, and any unexpected conseq f ew studies deal

Of course, each of these issues are interre

equally well with all of them. , t ive research. The first, ultl-

Herzog distinguished tliree types ° . xh!s approach is

mate evaluation, is generally desire Y nt program or a service

concerned with the degree to whic a suc h a question is too

helps those it serves. Unfortunate y, 8 e ” . To speak of the effec-

broadly drawn to be answered in a sin £ attempting to evaluate in

tiveness of psychotherapy may be as ru , approach, pre-evaluative

general the effectiveness of surgery. answer questions nee mg

research, is the type that must be c f ne can be done. Pre-evaluatiye

answers before satisfactory evaluative s s are to be produce , >

research involves issues such as w . ,u, e- This approach can ea

whom, by what means, by whom, ant as we ll as’to changing 1

the reformulation of mental healt P r ]t ; mate evaluations. For ex '‘
concerning what might be desired from stop asking whether

pie, as the® result of proevaluative regard. £ , particu a ap.

psychotherapy is effective and start a g oducing particular ype
proach is with particular kinds of P^‘J atio n is short-term evalua
of changes. Finally, the third approach to

450 / research m community psychology

tion, research that can be carried out within a few years It can be useful
in dealing with problems in the here and now and can be applied short of
extensive pre-evaluative research It cannot, however, provide the long
term answers that people most desire Such answers must await extensive
pre evaluative research

Herzog offers certain admonishments with respect to undertaking eval
native research Tirst, she suggests that one not embark on evaluative re
search if the purpose it is to serve can be accomplished in some other
way, since research of this kind is expensive, time consuming, and diffi
cult to carry out Herzog warns against relying on agency records as the
exclusive source of data in an evaluative study, since these records
often lack data essential to the proper conduct of the study Furthermore,
they are seldom comparably explicit and detailed Herzog recommends
also that a great deal of time and effort not be spent in being precise
about one feature of a research program, out of all proportion with other
features For example, little is gained m being extraordinarily precise
about the reliability of measures, if the criteria used are relatively ambig
uous

Herzog points out that certain factors are essential to good evaluative
research These include bringing the researcher into the project early
enough and thoroughly enough to do a proper job, having ‘'intellectually
hospitable researchers and practitioners on the team, and having re
searchers who appreciate the potential rewards of evaluative research and
coordinated efforts

Certainly another significant set of problems in the conduct of evalua
live research relates to the generally long term nature of such an enter
prise To determine whether a program has had a significant effect often
requires continued study long after the program has been instituted or
comp ete is requires keeping in touch with a significant portion of
the subject population over very long periods of time Among certain so
dal groups and in groups residing m certain locales this requirement is
difficult to achieve

All of the problems assorted with evaluative research contribute to
its high cost which, in itself, becomes a problem Many funding sources,
as well as the general public are much more willing to provide funds for
service programs even untried ones, than to put large sums of money
into evaluative research Service programs can often be "sold” on the ba
sis of the faith and the enthusiasm of us developers, and they offer the
hope tint some goodwill be done for needy individuals The researcher,
on the other hand, is often less convincing m Ins enthusiasm for the re
search enterprise and, at best, can only produce documentation of the
effectiveness of a program whose worth may have already been accepted

EVALUATIVE RESEARCH / 451

on faith At worst, the researcher can shatter the illusions of service provi
ders and those who badly tv ant to see them succeed Thus funding for
evaluative research must be provided by individuals or agencies taking a
coldly rational viewpoint concerning the whole community psychology en
terprise Since large amounts of money are more likely to be provided for
enterprises that seem exciting and of immediate benefit to needy individ
mis than to research enterprises that are very lengthy, complicated and
potentially deflating, the acquisition of funds for evaluative research re

mains a serious problem

Since examples o£ cvahnte research studies have been liberally re
viewed throughout the preceding chapters of this book, none wi e con
sidered m this section in detail A variety of community psychology pro
grams have been subjected to more or less systematic eva ua 1071
include Riocli's program for training mental health coun^o s tGolann,
Brener, and Magoon. 1966, Magoon and Golann, 1966 ). nc 1 he^f
fects of a student volunteer program in a hospital setting ( JM5
wirtz, and Ebner, 1964, Ho.zberg, and Knapp, 1965) ; "
Chapter 3 Several studies evaluating the e ects o a g68

on chronically disturbed mental patients "47 Gold, a

Ayllon, 1963, Ayllon, and Aznn, 1965, (Fal rwea.her,

mond, 1960) as well as other types of Hendcrson , 1971,

Sanders, Cressler, and Maynard, I960, S^ m chapler 4 In

Sanders, Smith, and Weinman, 1967) „ ams for stimulating

Chapter 5 are discussed evaluations of P Irwin, 1960,

infants and preschool children (Gray, an ^ Q ra y, 1968,

Karnes, Teska, Hodgins and Badger, ’ cffcct5 o£ primary pre-
Rheingold, 1956, Skeels, and Dye, UW) dere d m many evaluative

ventive efforts in the school system LevI u, 1955, Minuchm, Bi

studies described in Chapter 6 (Leton, ’ jemann , Levitt, Lyle,
ber, Shapiro, and Z.m.les, 1969 Muss 9 1968) while m

and Whiteside, 1955, Thomas, Bee e , ventlV e program evalua

Chapter 7 are examined several sec0 ” n( j £ax, 1963, Cowen, Zax,
tions (Cowen, Izzo, Miles, Telschow, ’ jg57) Chapter 8 de

Izzo and Trost 1966, Gildea, Gllde ' ve ’ „ an , s conducted on col
scribes the evaluation o£ several presen M ied enthal, 1968, Sinnett,
lege campuses (Kysar, 1966, Sinnett, and ^ Web s.er, and

W.esner.and Fneser, 1967, Sp.e berger & We . based in

Harris 1958, Wold, 1969) FinaU,. evato^™ g ^ IcCord , McCord
the greater community are presented n C P , 96 8, Sarason,

and Zola, 1959, Powers, and W.tnrrer, »>■

Ganzer, 1969, Schwitzgabel and Kol ,

452 / research in community psychology

CONCLUSION

Community psychology, as a new approach to dealing with behavioral
problems, must have its procedures and techniques established on sound
empirical bases and its program shaped by realistic needs In bringing
this about, research will be fundamental This research can be devoted to
locating parts of the community that have the greatest need for service,
can be essential in establishing which social forces are detrimental to
good mental health can be used to help create optimally efficient service
delivery programs, and can be used to test the effectiveness of estab
lished service or training programs

Characteristically, it has been easier to generate enthusiasm for the de
velopment of service programs that promise to improve the lot of suffer
mg individuals than for the development of research programs A further
barrier to the establishment of the type of research programs needed m
community psychology is that the traditionally trained psychologist is not
well prepared for many of the relevant approaches Furthermore, re
search in naturalistic settings, such as is required in the ecological ap-
proach, and system analysis techniques are only now being developed
Thus the community psychologist who would like to apply these ap-
proaches is virtually compelled to participate in developing basic research
methods before he can do so

Evaluative research is the approach relevant to community psychology
for which the traditionally trained psychologist is best prepared Howev
er, even research of this kind is not easily implemented because of the
considerable time and money it requires as well as the many methodolog
ical difficulties involved in carrying it out

Despite the many realistic handicaps to engaging in research, it is ab
solutel} essential that community psychology take up the research quest
very seriously This is particularly true because, as a relatively new ap-
proach to dealing with behavior disorder, community psychology is com
peting with an order that has been established over a period of years To
supplant an already well-established way of looking at problems and
dealing with them requires a monumental effort In some respects, this
enterprise can be likened to building sand castles on the seashore As
long as the castle builder is present and willing to invest a great deal of
energy into repairing breaches in the wall made by the incoming tide, he
can preserve the semblance of the castle Once his enthusiasm flags, or he
leaves the scene, it is simply a matter of time before all signs of his pre-
vious presence are washed away Community psychology faces that dan
ger Only a solid empirical base for its programs and techniques, and
good evidence of their effective outcome can lead to the building of per-
manent walls resistant to the tides of tradition

REFERENCES / 453

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i6. summary and prospects

The purpose of this chap\ex is to highlight the hook’s major points and to
forecast the direction of future development in community psychology
Hopefully, a broad summary of what has gone before will provide a
background against winch a meaningful forecast can be attempted

We first considered how community psychology is defined Unfortu
natcly, it was not possible to offer a concise definition on which all have
agreed It was pointed out that a number of terms have been bandied
about in the past several years that include the modifier "community”
Community psychiatry and community mental health are two of these
terms Social psychiatry is another that has been widely discussed and
that seems to bear some similarity to community approaches A wide
range of definitions was found for each of these terms with a considerable
overlap between them Definitions of community psychology were less
variable, but they, too, overlapped considerably with the other terms gen
erally used in the community area The seemingly best resolution con

SUMMARY AND PROSPECTS / 459

cerning a current definition of community psychology is to extract the
common denominator running through varying definitions and to couch it
broadly enough to encompass most program approaches that are general-
ly regarded as exemplifying community psychology efforts From this
viewpoint, community psychology is an approach to human behavior
problems that emphasizes contributions made to the development of
these problems by environmental forces as well as the potential contribu-
tions to be made toward their alleviation by the use of these forces. Such
a definition is sufficiently abstract to embrace under the community psy-
chology rubric the programs that attempt to deal with be iavi °r P r °
traditionally regarded as being in the province of the ea ,

as well as the problems with which the mental hea e a
cently become concerned. It encompasses the study o m ivi ua
ural social settings, active intervention to prevent future sness and the
creation of social settings to enhance the positive aspec s

. The llistor V ° f community psychology has ^^^^^etTv^the centu-
mg conceptions of behavior disorder. Tr S.“ rdcred behavior focused
ries shows that man's earliest concern a relatively narrow view

on the very deviant and the very dramatic. J9[h ccntur y. One of

pertained among most professionals up to . ni of the scope of

Freud's most significant contributions w honcurotics- Furthermore,

behavior disorder through his interest in psyc ment 0 f neurotic

the theories that he advanced for explaining sub[ i e behavior

disorders paved the way for the recognition o concerns for the mental
disorders, the character neuroses, as legitim

health professional. mental health field has per-

This tendency to broaden the scope . j iave become sensitive to

sisted to the point where the mental hea t such ^ the failure to

a variety of relatively subtle behaviora p fit from life’s opportum-

utilize inherent potentials, and the ai ure ^*as extended, re-
ties. As the concern of the mental e larger numbers of peo-

sponsibility was undertaken for dealing " health field have seemed to
pie. The major revolutions within the men advances, but because

come about not because of important redefinitions prompt

of periodic redefinitions of the fiel s nt 0 f new ways of loo ng

the advancement of new ideas, the e '^ and t h e development o ncv.
at and attempting to understand e a ' x ' JOT1S Community psy °
approaches for dealing with behavior f", feld^

is seen as the most recent revolution m „ n “

ed by a scope-broadening redefinition. One «« ^ th' lutur

such scope-broadening has reac e & s mandate,
might not see some retrenchment on

460 / summary and prospects

Why should the mental health professions be broadening their scope at
this particular stage in time? The answer to this question relates to a mu!
titudc of factors that seem to have converged in recent years Certainly
one was the emergence in the 1950s of much questioning of the effective
ness of traditional mental health functions Such expressions shook com
placent professionals and caused them to examine more carefully what
they were doing and how effectively it was working with the result that
many began casting around for new approaches Another aspect of the
discontent with traditional mental health functions was a growing dissatis
faction at inequities in the delivery of services associated with traditional
practices The disadvantaged, most seriously disturbed segment of our
population seemed to be receiving the attention of the least qualified and
fewest number of mental health professionals, whereas the advantaged,
among whom serious disorders were relatively few m number, benefited
from a heavy concentration of professional resources Furthermore,
large scale surveys uncovered a staggeringly high latent need for mental
health services m the general population, despite the fact that most pro-
fessionals were already hard put to cope with those having manifest
needs

Certainly another impetus to the recent development of community
psychology was the ominous finding concerning the manpower situa
tion m the mental health field While the lack of sufficient num
bers of professionals to deal with current mental health problems was ob
vious the hope could be cherished that somehow the gap between the
need for services and the supply of those who could render services might
be closed by additional training efforts Careful studies of this problem,
howe\er, revealed that the reverse was likely Not only would manpower
needs in the mental health field not be overcome in the foreseeable fu
ture, but it was even more likely that the gap between need and supply
would widen

Concurrent with the recognition that existing services and delivery sys
terns were failing to meet societal needs doubts grew among psycholo-
gists about the ultimate utility of the conceptual model on which the men
tal health establishment has been based Community psychologists came
to decry the fact that the typical mental health practitioner uses a service
approacli deriving from the medical model The aspect of this model
that creates the most serious difficulty for the community psychologist is
the passivity it imposes on the professional, blocking bis engagement with
the external forces seen to be so important in the development of disor-
der The typical pose of the medical model practitioner finds him waiting
in an office for a “patient to present himself with a fully developed prob
lem that the practitioner must deal with within the confines of that office
This leaves little room for environmental manipulation, or active preven

SUMMARY AND PROSPECTS / 461

ti\e efforts Thus considerable questioning of the medical model has oc
curred, and particularly for the community psychologist, some aspects of
the model have been rejected On the other hand, public health medicine
has developed an approach tint is much more relevant to the type of ef
fort tint the community psychologist would like to expend This allows
one to reach out into the community, to take steps to manipulate t e so-

cial structure in growth enhancing ways, to attempt to uncover environ
meml contributions to the etiology of various behavior disor ers, an
bring about environmental changes that nullify their effect

Amidst the pessimism concerning the worthwhileness of continuingto
apply traditional approaches exclusively, and the uncertainty *
having sufficient manpower to do such a job proper y, t le e
public 8 health medicine Has offered a ray of hope Epidemiological .tud «
hare helped to isolate the causes of some physical “““m
to effective prevention Tor many, this example of attempting P
the development of senons behavtor dtsorder has*emed the onlyfca^
ble approach Fortunately, the 1940s provi e menta \ health field,

which one could apply preventive erge that had tied to it

and during the 1950s a body of theory beg a t S angl bl e basis was es

many suggestions for practical applications ' and tertia ry preven

tablished for programs aimed at pnma y

tion that occurred in the 1950s and

The questioning of the establishment ]ed to many bold new

the searching for new models of these new programs was an

programs in a variety of settings U „ f orccs to cause, worsen

increased emphasis on the power of co , [ unct ion Some programs
prevent or ameliorate human behaviora province of the mental

were directed toward problems m the tra character disorders Oth

health worker, psychosis, psychoneurosi » ^ jn dxvtduals who nor

ers preventively oriented dealt wit 1 on o£ a me ntal health pro es
mally would not have come to the atte 1 ^ mnov attve m that

stonal Although the latter programs * wlt h an entirely new ‘ n

they represented entirely new ways o to dea i with tra t

of service recipient, the programs t ia P ' udaclous because they e
problems seemed in many cases the m

the face of established traditions erop hastze traditional 1 F>

Some of these programs continu techniques con

therapy, but they challenged the notion aj- ■ efforts sough m

plied only by professionals In <®*t, th<* £ of , h0 se who e p ob

mobilize new segments of of

lems had formerly been P rim rr . vea r period to be p y .i iera py
Housewives were trained over a ^ were enlisted to lead P
College students with virtually no

462 / summary and prospects

groups consisting of seriously disturbed mental patients Seriously dis-
turbed youngsters of school age were treated in educationally oriented
programs in some instances, through the use of volunteer housewives
with teacher training and m others through specially trained educational
personnel In many cases such youngsters would normally have been ex
eluded from the school system and would have been confined in a resi
dential treatment setting In many hospitals across the country college
students were enlisted as companions to hospitalized mental patients in
the hope that they could motivate the patient to leave the hospital Com
munity mental health centers adopted many innovative approaches such
as the day hospital, the night hospital, foster home care, home treatment
services, and aftercare services

Interesting changes also began to appear within one of the most stodgy
of the traditional mental health agencies, the mental hospital Many be
gan to view the hospital as a community and to examine the impact that
the typical mental hospital has on the patient and his capacity to function
when he reenters the broader community Much concern was expressed
over the discrepancy between the behaviors required for adaptation to
life in a mental hospital and those necessary to adapt outside of the hos
pital Frequently it seemed that m order to be a ' good patient one had
to behave passively, without initiative, and to submit to a variety of in
dignities nil of which would mark one as disturbed m normal society
Hospital communities were, therefore, created or restructured to resem
ble more closely the community outside of the hospital In such hospital
communities, responsibility is given the patient, freedoms are available to
him, and he is expected to take an active part in deciding the course of
lus own life within the institution These innovative hospital communities
assumed a variety of forms with one even stressing the necessity for
groups of parents to learn to live together within the hospital and to be
discharged en masse to take up a communal life outside of the institution
as a means of minimizing discrepancies between hospital roles and real
world roles Philosophically most innovations in hospital programs are
oriented toward enhancing the patient’s capacity to live outside of the in
stitution An important unsolved problem is how to deal with the pa
ttent s extra institutional world to maximize his chances of thriving there
Discharging the patient as one of a group of patients who have learned to
live adaptively together amounts to creating a new institution that may be
necessary for some but is a poor solution for many

The community psychology model has not been confined to the institu
tions where mental health goals and methods were already evident If
positive environment forces could aid the social outcast to return to ade
quatc functioning such forces could similarly prevent the breakdown in
functioning from occurring in the first place. On tins assumption, psy

SUMMARY AND PROSPECTS / 463

chologists have begun to develop programs tint reach out to segments of
the community where tradttioml curative or ameliorative approaches are
inappropriate

Preventively oriented programs have emerged in a variety of realms di
rccted generally toward particular age groups or social classes Clearly, a
1 - fnr nM, Anhnn r, mo-rums has heen the very youn

ti generally toward particular age groups ui suuu
favorite target for prevention programs has been the very young It is al
most reflexive in thinking of preventing the development of a disturbance
to concentrate on the young Maladaptive behavior patterns among
youngsters are not yet vvcll entrenched, and the young are seen as ma ea
blc. Since they arc undergoing rapid personality change, positive in u
cnees arc thought to have a particularly high likelihood of aving signi
cant impact on the lives of vonngsicrs, and for the young t e ormation o
a foundation for future adaptation is considered to be particu ar y 1
tant In addition, parents generally have a great sta e in t eir c
sclopmcnt and future growth. and where work wtth P^nts arounda
cluld’s incipient problems nny seem desirable, coopera ms be

easily attained It is for these reasons tint many P re ”" , £ Genera lly
gin asith preschool children and, at times, esen wt [he stimu

these programs arc directed toward clnltl ren ‘ j ’° ’ * ann „ ,hem to make

latton in titer normal enatronment necessary p [t J ]ow Unfortunately,

the most out of the scltool experience t more enthusia5 m than

many such programs base been approac ^ a , together encouragtng
thoughtfulness, and their effects base n , imm presstve results will

The danger in tilts is that dtscouragcmen young, despite the

turn program designers away from work w.th he aery >o g
compelling arguments tint favor procee access point for employ

Just as the mental hospital has been a pn ^ c f t hose who

mg the concepts of community psyc ° °gy ^ school has been the lo
have already experienced psychosocia ai » w h 0 h aV e not yet been
cale for many programs that seek to sene setting has been a

severely harmed by environmental » orces nreV ention programs Pn
popular site for both primary and secor \‘ £ ocuse d on the total schoo
mary preventive programs have in some ‘ , te psychological deve op-
atmosphere with the aim of qvp concentrated on introducing

ment Other primary preventive e or | 1 ^ vOU Id have widespread im P a ^
mto the school curriculum materia s hirt j primary preventive p

on the adjustment of all students expose Generally, this approac
proaclt aims at altering teacher tec mq 1 to sensitize the teac er

practiced by behavioristic psychology s desira ble behavior, and ?
the role that she plays in perpetuating shape desirable «

her how, through her own responses, she ca f > d young er

Such efforts are generally directed tow rd the ^ ^ [he impr „ved

hm are seen to have primary preventive imp

464 / summary and prospects

classroom atmosphere attending their success benefits all students. In the
same sense, secondary preventive programs inevitably have primary pre-
ventive impact.

Several widely known secondary preventive programs have been insti-
tuted in the schools. Always concerned with identifying a target group
manifesting the early signs of a problem, these secondary preventive pro-
grams have focused either on the parents of problem children, teachers,
the children themselves, or on some combination of the three. A few sec-
ondary preventive programs have extended over a period of years and
have undergone many metamorphoses in keeping with specific experi-
ences. These programs seem to have demonstrated rather clearly that be-
havior problems can be identified in their incipient stages, but the overall
effectiveness of preventive efforts is less well established. This is partly
because evaluations of this kind are difficult to do and partly because the
interventive models had to be built from the ground up making a fair
amount of testing and changing inevitable. As in the preschool area, the
absence of definitive evidence of the long-range success of secondary pre-
ventive efforts should not discourage continued and energetic effort. The
potential gain of program success far outweights the costs of program
failures experienced in the process of working out a worthwhile model. In
this area the most significant need is for the arduous process of program
creation , implementation, and evaluation until well-tested models become
available for widespread use.

Another important arena for the establishment of preventive programs
is the college community. The significance of this setting for prevention
derives partly from the fact that it brings together young people at a point
in life when their futures are being shaped in important ways. For many,
too, entrance into college represents one of life’s significant crisis points.
Many college students will be living away from home for the first time,
will be threatened by the need to establish an entirely new set of friends
having diverse backgrounds, and also of having to prove themselves aca-
demically in a more select group of scholars than they have ever before
encountered. Furthermore, the college experience is a final preparation
for becoming an adult and settling on a life’s work. In addition to these
compelling arguments for the necessity of establishing preventive pro-
grams in the college setting, another advantage of working in those set-
tings is that many program designers aTe themselves members of college
faculties. Thus, presumably, they are on familiar turf in a community of
which they arc themselves a part.

Despite the significant arguments favoring creating preventive pro-
grams on college campuses, and despite the fact that a vast number of
modern universities have accepted responsibility for seeing to it that a
student’s emotional state is conducive to benefiting from the educational

SUMMARY AND PROSPECTS / 465

opportunities before lum, relati\ely few preventive program models have
emerged in the college area Doubtless, this seeming paradox is related to
the fact that the community psychologist, as a member of the university
community, may suffer some unique problems in acting as a change
agent m a system of which he is a part Precisely because he is a part of
the community, any effort he expends toward changing it, especially in
areas for which other community members have primary responsibility.

may provoke unusual resentment and resistance

Some data on the impact of small programs in college settings a\e
shown that limited interventions have positive effects but fai to reac
many students whose need for service may be as great or g re j lt <' r 1 n
that of program participants Wide scale programs have provi e in er
estmg models of new forms of service delivery but have een 1 “
implement No doubt, the advantages offered by the co ege ca ™P
community laboratory are too attractive to he fallow for the .ndefimteju
ture Very likely more extensive efforts will be expen e
mumty programs in the future The most ^^J over Jays to make
ers in the college community mil be the ne w

that setting a truly growth enhancing edu ’ aho nal enter

spects, is altogether in keeping with the go J

P The choice by program innovators lo focus o"f

specific community settings, such as sch °° pennon programs in

a practical decision than a theoretical ' ]ementat ,on problems

the community at large have posed pe ^ [he ^efic agenaes

Most community programs have been " ea population Reaching out
that bring together large numbers ot t ' 6 that allows contact

toward the wider community requires Nonetheless what can be

with those to whom service is to be broug communl[y have a rela
looked on as prevention programs in _ ew up during times ot

lively long history A number of these progr than mental health

social upheaval and often were promulga the pro duct of a reh

professionals The Salvation Army for examp The I9th a „d early

gious group concerned with rehabilitating ( j 1I( , (re( l by idealists w 10
20th century settlement house movemen problems created by ie

were attempting to grapple with ^*>“ S ”t.on Programs or con
industrial revolution and great wav instituted in the

trolling and treating juvenile delinquency woe deeply concerned

Chicago and in the Boston area by p^^ n „t trained men
with crime as a social problem but w 10

tal health workers as v-ere many,

Recent efforts in the greater com ro^ ^ pro blcms of slotting p I>
community programs have been ire

466 / summary and prospects

ulation groups. In the contemporary context this includes the adaptation
of the newcomer to this country (Puerto Ricans) , the comfortable assim-
ilation of the rural black to the large urban area in which he is resettling,
the proliferating delinquency problems of America’s cities, and a concern
with helping the economically and educationally disadvantaged to achieve
meaningful life careers.

In many respects these programs seem more remote from the tradition-
al mental health enterprise than any that have been discussed up to now.
Their emphasis has been almost entirely on education, assistance in cop
ing with practical everyday problems, and the provision of good identifi-
cation models. Intrapsychic forces have been virtually ignored. These
programs, too, have brought the mental health professional into an arena
with which he is least familiar, the traditional stamping ground of the pol-
itician, the police, the social worker, the clergy, and the courts. It is still
too soon to judge the long-range impact of such programs. What does
seem clear, however is that the mental professional engaging in broad
community programs has been significantly reshaped by his experience.
In this reshaping process a number of difficult issues have yet to be
solved by those attempting to create programs in the greater community.
Some of these include the question of how to gain the acceptance of those
to be served, establishing a locus for providing services, resolving the
question of the role political action is to play in such programs, facing the
question of what assets and liabilities the professional possesses for en-
gaging in the political struggle, and what role he should assume in such an
enterprise.

While the arguments favoring the development of community psychol-
ogy with its revitalized efforts to combat mental disorder and its exciting
prospects for preventing the development of emotional disturbances are
persuasive, the field is nevertheless confronted by many problematic is-
sues, and by criticisms from a variety of source. Objections to the devel-
opment of community psychology arise both in society at large and with-
in the mental health professions themselves. Criticisms from outside of
the mental health professions tend to come from those who recoil at the
projected high cost of wide-scale preventive programs, who express deep
concern that preventive programs invade an individual's personal priva-
cy, and who are distressed at the lack of an immediate payoff in com-
munity programs. In addition, such critics probably also harbor an un-
conscious need for society to be populated by "winners”, and "losers.” On
careful reflection, many of these concerns seem less serious than they ap-
pear at first blush. On the other hand, society’s need for winners and los-
ers in life touches on some very basic human values that are not readily
altered. The winners and losers theme is based on the idea that every
man has an equal opportunity and that the well intentioned and hard

SUMMARY AND PROSPECTS / 467

working will succeed whereas those who fail are somehow lacking in the
proper sentiments or motivation According to this view the successful
man can take comfort in an obvious sign of his inner goodness and can
complacently look down on those failing to achieve his measure of ac
complishment In many important ways, community psychology calls this
theme into question, attributes the success of many to their having started
out with advantages, and denies both the inherent goodness of those who
succeed as well as the inherent badness of those who fail Still the atti
tudes arc there and how does the community psychologist go about alter
ing them'* .

Among mental health professionals opposition to community psycho o-
gy is expressed in a questioning of the quality of treatment at cornmum
ty psychology approaches can provide for previously neg ecte so i
classes, and m disagreement with die theoretical viewpoint of com Y
psychology on the etiology of behavior disorder Less i exp nitj s ^ ^
feeling of threat to a well-established professional ,

that this concern over having to give up a well g

mg is the most serious threat felt by professionals and ^ng a very^,
cult thing to talk about overtly, it prompts o jcction ^ of

terms In truth, the community psychology mov “”' e dehvery an d the
tional services as well as traditional modes o mental health

proposed new programs do require drasucrev^ ^ pving up on

workers professional way of life That J early training and

much that lias been traditional in the pr es t a bhshed considerable
undertaking retraining at a time when ie ^ at JS st ,u honored by
status and has invested considerable ego in a r practioners need

a large segment of society Although tra ltJ ° n * oQ5€ to con tinue their old
not be left without clients to treat ana can umty psyc hology and

functions unimpeded, the very existence o ^ as grown inevitably un
the dissatisfaction and turmoil out o w status on the traditional

poses discomforting doubt and a threat o threat posed by com

mental health worker How, then, to e significant problem

mumty psychology to the traditional ty psychology from sever

Along with thfopposmoi. faced by “"“"a It with m the field u
al quarters one of the serious issues that mu d for the new roles that
the question of how professionals are to the professional in o

must be assumed Gm.mun.ty m contact with many

many arenas where he has not operate P w here he is ex pec

types of people he has never had open™" W hat form of training
perform many functions that are quite new ° h ^ ^ la

will best prepare him for those experiences?'^ The ly point

lively little agreement concerning a “ P m ,mng models shou

on which most trainers agree is sat r

4G8 / summary and prospects

instituted, but that a variety of different approaches must be attempted
since the field is in a formative stage To some extent this idea sounds
like an attempt to create virtue out of a chaotic and terribly ambiguous
situation On the other hand, it is a fact that no one can yet predict the
many directions that community psychology may take and the many
skills that may be required of its practioners In such a case, flexibility in
training is probably the only feasible course It is already apparent, how
ever, that community psychology is a sprawling field that can move into a
variety of social institutions, each having its own unique framework and
its own special problems That being so, it is unlikely that any training
program can hope to produce a generalist prepared to operate in any
community setting Thus it is expected that future community psychology
training programs will tram specialists to function in schools, mental hos
pitals, neighborhood service centers, university communities, and the like
Much as we may prefer a community psychologist who is a "universal
man ” the field probably has already outgrown such a practitioner model
The need to create training programs in an applied field that is itself not
well formed is a formidable task confronting the community psychologist
How can he make his best educated guesses about the shape programs of
tins kind should take even in their nascent stages and what must he do to
test his hunches ?

Another issue confronting the community psychologist concerns the
role of the nonprofessional in community programs Clearly, one of any
community’s most important resources for coping with adverse circum
stances and for improving the lot of the suffering is its own strongest
members Thus the so called ' nonprofessional’ has been enlisted in
man) community programs to provide needed manpower, to serve as ade
quatc models, and to serve as a bridge between the middle class profes
sional and a community be is trying to help but which he does not com
pletcly understand, with which he may have difficulty communicating,
and by which he is not completely trusted

As is true with a number of other innovations introduced by communi
ty psychology, the logical argument for using nonprofesstonals is compel
ling but actually implementing a program involving nonprofessionals is
fraught with a variety of practical problems Developing techniques for
selecting and training workers is the first of those problems A review of
programs involving nonprofessionals reveals that no widespread model
for dealing with these issues lias been developed Another problem has to
do with how the nonprofessional is to be used in a specific program, what
type of service he is to render Again, actual cases indicate that nonpro-
fessionals arc used in .a variety of ways Some are restricted to relatively
menial and routine functions, while others are frontline workers Fre
qucntly, nonprofessionals become pawns in a struggle between profes-

SUMMARY AND PROSPECTS / 469

sionals, agency administrators, and fund-granting agencies. Another
problem in the use of nonprofessionals involves the necessity of develop-
ing satisfactory working relationships between professionals who are
threatened by the nonprofessionals' presence but who must still supervise
them and accept them as colleagues. Yet another entire class of problems
relates to the indigenous nonprofessional’s need to abandon an old life-
style when he becomes a human service worker. This new life-style, while
having many advantages, inevitably isolates him from the community in
which lie has been living. Furthermore, in the new life-style lie becomes
aware of a status hierarchy in his service agency in which he finds him
self on the bottom with the professional at the top. This often prompts a
new conflict and the expenditure of considerable energy towar orgamz
ing, and struggling with the professional for status. Each o tiese pro
lems drains energy that could be used in carrying out the nonprofessio -

al’s primary function as a service worker.

Another major class of problems for the community ps>c .

volves the question of what is the optimal role o t e com
en program Ideally, the community served should
identifying the needs to be met, and the means y w i commun ity
with them This would insure that important segments of [

would not he neglected, as they have Unfortunately,

cy's services would be relevant to the comm difficult to lo-

communities are difficult to define, their repres ts than any other

cate, their spokesmen are no freer fr °™ J^f bout society's long neglect
individuals, and their simmering resent ive of the ver y agencies

of them often boil over in ways tiiat are (q (hem

that are now struggling honestly to be o > some ^ cMnmunity psyc hology
In the final analysis, many of the p operation of social forces

can only be answered by carefully stu yin ^, to effect their members
and the means by which communities can c j s esse ntial to prog-

more positively. An extensive investment in epiclem iology and ecol-
ress in the field. Badly needed is basic resea F necessary to identify

ogy to provide the understanding of the c define program forms,

the most appropriate program targets, anc w jll require a new kin

For most psychologists, engaging in t u! i « ' } ent Q f new research ap-
„t participation in die develop j ^ „ v , pns ive evalua-

training and service programs and lor t e e j be discarded,

the investment of energy and time and " „ ex.raord.nanly d f

Forecasting the future of community rf definition , £

..:n nnttp new, it beks a “8 directions at the

iicult. The field is still quite new '.
scope is uncertain, and it is developing i

470 / summary and prospects

same time. Separate movements within community psychology are pro-
ceeding in response to felt social needs rather than on the basis of sound
theoretical knowledge. No base of previous experience exists on which to
build, and in a very real sense the field is lifting itself by its own boot-
straps. Given this amorphous, changeable state, only the foolhardy would
attempt to predict what is likely to happen next. Having acknowledged
the futility of the venture, we can with impunity attempt to predict what
future trends seem likely.

Perhaps the safest prediction that we can make is that the future will
find less proliferation of programs than has occurred in the past. Caught
up in the venturesome spirit encouraged by community psychology, pro-
gram designers have been quite daring in the types of programs that they
have created. Old taboos have been violated, old standards have been ig-
nored, and programs have been created in parts of the community that
have never before seen the presence of mental health professionals. By
now, so much new ground has been broken that it is difficult to conceive
of a program that will seem innovative. On the other hand, experience
with novel programs has raised a number of important implementation is-
sues that must be worked out.

Thus, while in the future there should be a development of fewer un-
precedented types of programs, much community psychology literature
should be devoted to problems arising in the carrying out of innovative
programs. For example, further experience with the use of nonprofes-
sionals and continued efforts to enlist community agencies will build a
body of experience leading to the development of principles that are use-
ful in guiding these efforts. No doubt, rigorous efforts will be made to
evaluate various aspects of community programs as well as their overall
effectiveness, and such results should also contribute to the development
of principles that will assist those who would develop programs based on
established models. In general, therefore, we predict that daring innova-
tion will be less common in the near future, and that a period of consoli-
dation will set in that will allow for the creation of programs based on
something more than enthusiasm and intuition.

Associated with the conservatism that is forecast, some amount of re-
trenchment in community psychology’s scope seems likely. It is entirely
likely that program evaluations will at times be so discouraging as to
prompt an abandonment of certain efforts. In some instances this may be
an unfortunate result whereas in others it may be entirely appropriate.
Community approaches cannot be expected to succeed in all of the di-
verse areas to which they have been applied. It is also conceivable that
members of other professions will alter their functions in such a way as to
obviate the necessity for the intervention of the community psychologist
For example, professional educators might change their techniques in

SUMMARY AND PROSPECTS / 471

such a way as to deal more effectively with many of the problems that
mental health professionals have been attempting to treat in their pro-
grams It is also possible that politicians, courts and law enforcement
agencies might change their approaches in ways that will make the men
tal health professional s efforts unnecessary
Another likely occurrence is the institutionalization of new classes of
mental health personnel These are likely to occur at all levels of training
to serve a variety of functions Where not too many years ago tee o
psychology was insisting that the full fledged practitioner must a\e a
doctorate, subdoctoral people are now playing and will continue to play
an ever more significant role in community psychology Wor ers wit i
than doctoral training will very likely serve in growing num rs in
front lines as direct service givers while doctoral leve personne '
program designers and supervisors Already many state me " a
systems have provided positions for subdoctoral menta ea o[

community mental health centers are hiring them to P rov ‘ ,,j [or
services, and governmental agencies are establishing « ee
them As this movement develops further it *eems likely th« ham J
programs for predoctoral workers will begin to ta • Dcie j

variety than has been true of many of these P r0 S r ™ P d d erslty than
opment of tangible models will result m k» novelty and divers y

Has existed in the past , , , to ^ concentrated in the

Research in community psychology is > . o become in

area of evaluation This is because the majori y ^ lo concerned
volved in community psychology at this stage ^ t f lcir mtcrests ex

with creating services to meet pressing human n j^ely focus on the
ceed the bounds of providing service, t ie > '' f future is not hhel> to
evaluation of their own service programs 1 rc j 1 characterized by the
see much concentrated effort on the asic r . d m a previous chap*
epidemiological and ecological approacies x v.icc pa>off Basic re

ter, since such research promises no imme nsvchology attracts large
search may await the time when commit ^ psjcholog), 5l,c ^ 35

numbers of workers from areas other t n SO ciolog> Those pro-

social psychology, developmental ps>c 10 > ’ c i l0 ] 0 gist to be heavi ) ,n

fessionals are less likely than the clmica P draBn , 0 ward basic re
vested in service programs and are more training programs i

search problems Thus far even cl* is “ *

nested in servi

search problems Thus far even tllc is desirable re '

community psychology have P rotab > H fu il ) , that stale vmII ebang ^
tract other than clinical psychologists^ J ^ c|nn „ c T" c _ U '_' n "'^ tin ,
the near future But it is unlikel}

etuiij. ,

II change <jiucm»

the near future But it is unlikely U, ‘ ,L s j 10rt periotl of ume pa rt
produce much basic research in a re a 1 t IO performing s'

lady when one considers the obstacles that

search

472 / summary and prospects

Having made a number of risky prognostications, we conclude with
one more that probably entails greater certainty than any predictions
made up to now. Despite all of the forces ranged against its establishment
as a significant mode within the mental health sphere, community psy-
chology has established a foothold that is likely to be permanent. It is
fueled by an idea that seems “right” to many individuals but that had
been badly neglected by psychologists for a surprisingly long time. At this
particular time its development is also greatly encouraged by exceedingly
important social needs that simply are not adequately met by traditional
practices. Thus whatever form it takes in the future, community psychol-
ogy is here to stay, and it is inevitable that future psychologists will be
shaped in many important ways by its presence.

Name Index

Aaronson, M , 138, 139, 140
Abbott, G , 230
Abbott, E , 230
Abidin, R R, 168,169
Addams, J , 230
Adler, A, 17
Ajax, 9

Albee, G W , 38, 39, 329, 372
Altrocchi, J , 360, 362
Anderson, L S , 1, 2, 339
Anderson, W ,217
Andromco, M P, 370, 382
Areen, J C,169
Armitage, S G , 110
Armstrong, M , 166,451
Armstrong R A , 428
Atlee, C , 229

Atthowe, J M , Jr , 111,451
Ayllon.T , 109, 110,111,112,451
Aznn, N H , 109, 110, 111, 112,451

Badger, I D , 141,451
Baer.D M , 370, 372
Bard, M , 273, 274, 349, 350, 352

Barger, B ,216,217,223

Barker, R G , 433, 434, 435, 436, 437,438,
439, 440, 443, 444
Bayley, N , 131
Beach, D R , 186
Beck, J c,64
Becker, W C, 166, 451
Beers, c, 316
Bell, A A , 155
Beliak, L.,5,7
Bennet Alder, L , 398
Bennett, C C, 1,2, 339

mett, E M, 156, 332
■ger, B , 204
kowitz, B , 273, 352
man, A L, 220, 221
nard.V W.5,8
nstein, B , 329
:z, B J , 38i

er B , 148, 151, 152,451
rer, J , 74, 75
dra, D , 30

dman, A 1,271,272
n, W R , 85

ach,G,221,222
om.B L, 20, 355
om, B S , 126

frEM^' 77 ' 180 - 181 ' 323 ' 324,

16,327 „ ii 118 119, 1M. 121

SS:S

chel, H , 199 33 3,394,395

,'v 7M76

S«,D E,56,«>
me ’' ° ' it ,17

pint,, T, MS. 217

„ R c 19,20,39
iwn, d a ,
wn, E L,90

«n.R d , 194 ;’ 97
wnbndge, R , 182
ceP, 163 _ , 7 4

IThe^o "«1. 1«

474/NAME INDEX

Campbell, D T , 135

Caplan, G , 5, 18, 42, 43, 44, 45, 46, 50,

125, 145, 148, 245, 271, 272, 273, 316,
338, 350, 357

Caikhuff, R R , 370, 378, 381, 383

Carlisle, R L , 194

Carroll, I F X , 155

Carstairs, G M , 447

Carter, J W , 161

Cartwright, D S , 30

Chandler, G E , 168, 169

Gterlm, D L , 156, 332

Chmsky, J M, 62, 370, 381

Christmas, 3 J , 370, 375, 376

Cicero, 11

Claiborn, W L, 221, 222
Clark, K B , 325
Coard, B , 398
Cohen, L D , 421
Cooper, M , 427
Cooper, S , 1, 2, 339

Cowen.E L , 20, 62, 184, 185, 186, 187,
188, 191, 193, 194, 243, 323, 324, 327,
330, 341, 370, 374, 378, 380, 381, 383,
385,389,420,421,448,451
Crane, J , 217
Cressler.D ,90, 106,451
Cnpps, S , 229
Cummin g J , 18, 20

Dalsimer J S , 62, 65, 370 376
De Charms, R , 30, 148
Dennis, M G , 127, 129, 144
Dennis, VV, 127, 129, 144
Dennison, G , 169
Dewey, J , 151

Donahue, G T , 66, 68, 69, 70, 71, 370,

380

Dorr, D, 374, 381
Duhl, L. J , 6, 403

Dunham, H W , 5, 317, 318, 319, 320, 322,
323, 325,427
Durham, D , 370

Dye, H B , 127, 128, 129, 131, 132, 144,
451

Dymphna, 74

Ebner, E , 66, 451
Edgerton, J W , 421
Eisdorfer, C , 4, 360, 362
Eisenberg, L-, 31

Eisenhower, D D , 32, 315
Eisenstadt, S N , 296, 297, 298
Eissler, R , 326
Elkes, C , 55
Enebacher, A , 1 35
Enkson, E , 17, 18
Eysenck, H J , 29, 30, 31

Fairfield, R , 279, 301, 304, 305
Fairweather, G W , 90, 105, 106, 107, 108,
112,451
Falk, R B, 212
Farberow, N L , 220
Fans, R B L , 427
Farnsworth, D L , 203
Farns, H E , 160
Feldman, K A , 223
Fellows, L , 370, 383
Fidler, J W , 370, 382
Fishman, J R , 268, 269, 270
Fleishman, S , 398
Flint, A A , 55
Fox, J T, 203, 215
Freud, A , 13, 17

Freud, S , 11, 12, 16, 17, 18, 22,41, 151,
330

Fnedman, S T , 158
Fneser, W S, 21 3, 451
Fromm, E , 17

Galen, 74

Ganzer, V J , 19, 20, 262, 451
Gartner, A , 370
Gelfand, S , 2
Geiger, J , 398
Gehneau, V A , 64
Gewirtz, H , 66, 451
Gildea.M C L, 174, 175,451
Ghdewell, J C , 174, 175, 448, 451
Goffman, E , 32, 118
Golann.S E , 4, 56, 57, 341, 342, 451
Goldberg, G S , 376, 384, 386, 388
Goldenberg, I 1 , 156, 249, 252, 332, 370,
382

Goldiamond, 1 , 110, 451
Goldston, S E.6,8
Goodman, G , 374, 378, 381
Gordon, J E, 375, 433
Gray, S W , 136, 137, 141,451
Grecnblatt, M A , 62, 65, 90
Greer, S , 399, 400, 401

NAME INDEX/475

Grosser, C , 371, 372, 376, 383, 384, 385,
388

Guerney, B G , Jr , 370, 382
Guemey, L F , 370, 382
Gump, P, 437, 438, 439, 440

Haggstrom.W C , 247
Hall, E , 216

Halleck, S L., 5, 317, 319, 324, 325, 328,
331,332

Hallowitz, E , 244, 247, 248, 370, 383

Hamilton, A , 230

Hams, F R , 370, 372

Harris, H, 206, 207,210,451

Hartmann, H , 17, 18

Hassol, L , 1, 2, 339

Havvkinshire, F B W, 371, 382

Helig, S M , 220

Henderson, D E , 160

Henderson, J D , 112,115,116,117,451

Hersch.C, 1,403,404,405

Herzog, E, 448, 449, 450

Hippocrates, 9, 10, 15

Hobbs, N, 66, 71, 73, 396, 421

Hodguis, A S, 141, 451

Holden, A C, 231, 232

Hollander, L , 1 35

Hollmgshead, A B , 33, 35, 428, 429

Holzberg, J D , 66, 369, 373, 377, 451

Horney, K , 17

Hotkms, A S , 135

Holt, R R , 16

Howell, R W , 8

Hume, P D ,5,8

Hunt, J McV, 126, 330

Hutcheson, B R, 445, 446

Hutchison, G B, 447, 44 8

kwin.O C, 141,451

Isaacs, W , 110,451

Hcoe, 1 , 158, 159, 338, 358, 365

Izzo, L. D , 184, 186, 370, 385, 451

leaner, E , 43

lohnston, R , 370, 383, 384
lones, M , 84, 85, 86, 88, 89, 90, 370
Jones, M R ,2

A J , 7, 8
K ahn, R L.331

Kanter, R M , 279, 280, 281, 282, 283,

284, 285, 287, 289, 290, 291, 292, 294,
297, 298, 299, 300, 304, 306
Kantor, D , 64, 65
Kantor, M B, 174, 451
Kaplan, S R , 243
Karnes, M B , 141, 143, 144 451
Kaufman, G , 194
Kelley, F , 230
Kelley, K K 112 155
Kelly, J G , 2, 154, 155, 169, 204, 435,
440 441,444
Kent, N D.160
King, G F.110
Klaus, R A 136,137,141,451
Kinkade, K 302

Klein, D C , 1, 2, 42, 204, 339, 362, 363,
401

Klein, W L , 66, 268, 369, 374, 377, 379,
382

Knapp, R H 66,451
Kobnn, R L , 320 322, 328
Kohler, M , 370
Kolb D A, 257, 457
Kraepehn, E , 10
Krafft Ebing, R von, 329
Kramet, M A ,423,424,425

Kramer, L, 109, 110, 111, 330, 451

Kraupl Taylor, F A , 85
Krause E A , 445 446
Kreitzer, S F , 370
Kretchmer, E , 329

£S?J E, 304.2.0, 45,

Laird, J D 186,378
Umb '" x j” 33” 7,429

Langner, T !>,«. •

Larson, C A, 180
Larson, E A , 20 ,

Lathiop, 1 , 230
Leighton, A H.428

Levsndge,D, 2t ^’

Levine, A , 228, 229

{JS;S:?56,2», 229.332, 339, 342.
. 34 . 3 ; 3 / 4 e?3U62.163.451

476/NAME INDEX

Levy, 3 , 30
Lewis, W W ,66,71
Liebowitz, E , 374
Liebowitz, G , 374
Lief, A , 22

Lindemann, E , 18, 41, 42, 48, 3S8

Lipton, H , 362, 363

Lipton, R C , 127

Lipzin, M D , 203, 215

Litman, R E , 220

Loeb, M B , 5

Lombroso, C , 329

London, P , 329

Long, S E , 19, 20

Lonon, R P , 34

Luton, F B , 427

Lowenstem, E , 17

Lowy, D G , 66

Lyle, \V H, 162, 451

Mabry, J , 166

Mackinnon, D W , 329

MacLennan, B W , 268, 384, 386

MacMahon, B , 422, 423, 447, 448

Madden, P G, 149,166

Madoma, A J , 385

Magenity, D ,218

Magoon.T M, 5 6, 57, 451

Maher, B A , 242

Maynard, H , 90, 106,451

McCarthy, B W , 220, 221

McColskey, A S.218

McCord, J , 242, 451

McCord W, 242, 451

McGehearty, L , 158

Mechanic, D , 5

Mensh, 1 N , 175

Merenda, J , 385

Meyer, A , 22, 40, 41, 320

Michael, J ,110

Michael S T , 33, 37, 429

Miles, H , 184, 370, 451

Miller, K S 421

Minor, M W , 155

Minuchin, P , 152, 153, 154, 451

Mitchell, L , 268

Montesson, M , 169

Mornson, A P , 62, 65, 370, 376

Momson, D C , 370

Morse, W C , 158

Mosher, R L , 148

Munk.B , 135
Muss, R E, 164,451

Neil, A S. 169

Ncims, G , 398

Ncwbrough, J R , 345

Newman, R G ,55

Newton, M R, 194,197

Njchtem. S , 66, 68, 71, 370, 380

Nicdenthal, L , 213, 214,451

Nisbct, R A, 401

Nixon, R M , 316

Nunn, D , 308

Ojcmann, R H , 161, 262, 163, 164,451
O'Malley, E E,160
Opler.M K, 33, 37, 429

Packard, R G , 167, 168
ftinzetta.A F ,402,403,405,409,410,
411

Pearl, A , 266, 267, 268, 374
Peck, II B , 243
Pepper, M P , 7
Perlmutter, F , 370
Peterson, R r , 370
Pierce Jones, J , 158
Pokracki, T , 381
Popper, H J , 268

Poser, E G , 59, 60, 61, 62, 66, 370, 377,
379

Powers, E , 233, 234, 237, 239, 240, 241 .
320, 451

Rrovence, S , 127

Pugh.T F, 422, 423, 447, 448

Qumney, R , 322

Rae-Grant, Q f 175, 176
Rapaport, D , 17, 29
Rappaport, J , 62, 370,381
Redhch, F C , 7, 33, 35, 428, 429
Reich, W , 12, 13, 17
Reid, K E , 203

Reiff, R , 2, 3, 20, 329, 339, 341, 34$, 375,
381,382.385,386,387, 388
Reifler, C B , 203, 215
Reinherz, H , 377
Renme, T A C , 7, 33, 37, 429
Rheingold, H L.. 129, 130, 131, 132, 451
Rhodes, W C , 345

NAME INDEX/477

Rickan, W C,372
Rickman, J , 85
Rieman, D W , 273

Riessman, F , 244, 245, 247, 248, 249, 266,
267, 268, 370, 373, 374, 375, 379, 381,
382,383,385,386,387
Ring, K, 11 8, 119, 120, 121
Rioch, M J , 54, 55, 56, 57, 58, 59, 61,

192, 370, 372, 377, 378, 383,451
Roen, S R , 150, 151, 162, 164, 165, 339,
342, 344,421,427,444
Roman, M , 243, 405, 406, 407, 408, 409
Rome, H P , 326, 327, 332
Rosenblum, G ,1,2, 339
Rosenhan, D L., 82, 122, 329
Rosenzweig, S , 30
Roth, W F ,427
Rudd, M , 409

Slack, C W , 257
Smith, M B , 396, 421
Smith, R , 90, 97, 370, 383, 451
Snow, W P , 422

Sobey, F , 369, 371, 372, 380, 383
Spano, B , 165

Spielberger C D , 210 211,212,273,338
345,365,451
Spiro, M E , 296
Spitz, R A , 127, 129
Spnnthall, N A , 148
Srole, L , 7, 33, 37, 429
Stachnik, T , 166
Stanfield R D , 242
Steenland, R , 217
Stringer, L A , 175, 176, 177, 178
Sullivan, H S , 17, 84, 85
Szasz, T S , 21

Sabshm, M , 7

Salber.E J , 396, 413, 414, 415
Samuels, J S , 112, 115, 116, 117, 451
Sanders, D H , 90, 106,451
Sanders, R , 90, 97, 99, 104, 383, 451
Sandler, 1 , 374
Sanford, N , 2
Sanua, V D , 34

Sarason, I G , 19, 20, 261, 265, 442, 443,
451

Sarason, S B , 156, 157, 305, 332, 352
Saunders, R , 370

Schaefer, E S , 138, 139, 140, 143
Schneidman, E S , 220
Schofield, W , 31

Schwitzgebel, R L , 257, 258, 259, 260,

451

Schoggen, P , 437
Scudder, W L , 230
Seeman, J , 345
Sells, S B , 433
Shakow, D , 29
Shapiro, E , 152, 451
Shaw.C R , 320
Sheldon, W H , 329
Silberg, E , 55
Simkhovich, M , 230
Sl nger, J L , 349, 350
Smnett, E R , 213, 214, 451
Steels, H M , 127, 128, 129, 131, 132, 144,
451

Skinner, B F , 109, 302

relschow, E F , 184, 370, 451
reska, J A, 141,451
rhomas, D R , 166, 167,451
rhomas J , 110,451
fietze, C , 427
rilton, J R, HO

techier, G L, 396, 415, 416, 417
fizard, J , 1 26
roffler, A , 400

r: e M A, m ,86, m3* >.«!

ruax, C B , 370 378,381,383
’ucker, B J , 218, 219
'umer, J L , 66
’urner, R J , IS> ^0

t p 109 110, II 1» 330
Jllmann L
Jlxich R > 166

rc 62 64,65,370,376,377

rmbarger,

Isdansky.B S,55

r an Vleet, P , 1 82

rahler, R G.370
raid, L, 230

rafter, W, 268 „ 451

9 0 320,383,451

478/NAME INDEX

Weisner, E F ,213, 451
Weitz.H, 210, 21 1,212, 451
Wertheimer, M , 30
Whitaker, L, 396, 4 11, 41 2
Whiteside, M F, 162, 451
Whiting, H S , 66
Wmkel.G H , 370

Witmer, H , 233, 234, 237, 239, 240, 241,
320, 451

Wolf, M M , 370, 372
Wolfe, A , 224

Wolff, T, 207, 208, 209, 210,

451

Wolpm. M , 370, 383
York, R H ,90

Zax, M , 66, 184, 185, 186, 187, 188, 191,
243. 330, 369, 370, 374, 377, 378, 380,
383, 385 , 451
Zimiles, II , 152, 154,451
Zola, I K ,242,451

Subject Index

A-B scale, 381

Academic Progress Chart (APC), 176
Achievement tests, 191
Achievement test scores, 184, 186
Action for Boston Community Development
(ABCD), 398

Action, interpersonal, 45,48
social, 45, 46, 48
goal of, 45
program, 45

Adaptation, process of, 18

Addiction(s), 14, 248

Administrative structure, pyramidal, 249

Aesculapean temples, 15

Aftercare, 22, 40

Aftercare movement, 22, 320

Aftercare services, 77, 462

After-school day-care program, 193

After-school program, 190, 193, 194

Agencies, family & child service, 58

Agencies, public, 33

Agencies, welfare, 58

Agency, social, 95

Agents, helping, 204

Albert Einstein College of Medicine, 243,
406

Alcoholics Anonymous, 5 1 , 373
Alcoholism, 23, 274
Alienation, 256

Alienation m modem society, 279
Alternative to state hospital treatment, 112
American Psychological Association, 421
American University, 220, 221
AML Behavior Rating Scale, 182, 184
Anesthesias, 10
Anthropologist, cultural, 400

Anthropologists, 365
Anthropology, 354, 358, 364
Antioch, 301

Antiviolence & antidrug campaigns, 248
Anxiety, 13
severe, 1 1
Aphasic child, 70
Apprenticeship model, 361
Approach, causal, 162, 163
Architect, 311, 350
Armed forces, 49
Artist, 343
Assault, 253, 269

AtttodM toward authontanaiusm, 256

re, Md ,307,427
reet approach, 151, 154

re et Metre of Eduction 151
rent Project, 151. 156,166

reet Team, 151, 1 52

r, abnormal, 9

jtions of! disordered, 9

^ 3 . 0,452 45M6!
Modification, 330, 370 '

s , oref.°ntlaborato.^«« 68 ,

modification program,

m ” d ' DOT 4 38 439
■settings, 438,4

479

480/SUBJECT INDEX

theory of, 439

Behavior therapy program for emotionally
disturbed children, 370
Behavioral sciences cumculunt for the ele-
mentary schools, 164
Behavioristic mterventive approaches, 16 6
Behefs, superstitions, 16
Bender-Visual Motor Gestalt Test, 184
ot social secvnty, \03
Bereavement, study of reactions to, 41
Big brother, 234
Big brother relationship, 233
Binet intelligence test, 142
Biologist, 444
Biology, 433
Biometncian, 306
Biostatistics, 340, 356, 357
“Bitch box,” 303
Black Panthers, 409, 411
Black revolution, 410, 411
Blindness, 10

Block cleanup program, 248
Boston, 465

Boston City Hospital, 397
Boston Conference, 2, 340, 364
Boston Psychopathic Hospital, 62, 90
Boston University, 1, 362
Community Psychology Training, 362
Human Relations Center at, 362
Boston University’s program, 363
Botany, 444
Boys clubs, 350
Brain injured, 72
Breaking & entering 253
Bridging system, 114
British Labor Party, 229
British Ministry of Health, Labor, & Pen
Sion, 85

Bronx, New York, 405
Building codes, 231
Bulbs approach, 161
Bulbs program, 161
Bulbs project, 161
Burglary, 253, 269
Business, 345, 362

California, 301

Calif oirua State Education Department,
177,180,181

Cambridge, Massachusetts, 234
Cambridge Crime Prevention Bureau, 241

Cambndge-Somemlle study, program, pro-
ject, 233, 240, 241, 242, 261, 318
follow-up of the, 242
Cambndge-Somerville Youth Study, 233,
320

Chmpus Cnsis Center, Southern Colorado
State College, 218
Career ladders, 471
Caiegvrets, 21 3 , 338 , 4 16
Caretaking, 371

Cascadia Reception-Diagnostic Center,
Takoma, Washington, 262
Case administrator, 342
Case-aid program, 64
Case worker, 253

Catchment area, 402, 410, 415, 418
Catholics, 430
Celibacy, 284

Center for Community Studies, 347
Centers, neighborhood, 58
residential treatment, 69
Cfcrebral palsy, 69
Change agent(s), 1, 148
Chaplains, 204
Character Analysis, 1 3
Character armor, 13

Characteristics, inheritance of acquired, 17

Characterologies, 329

Charismatic founder, 294

Charismatic leader, 290, 300

Charlatans, 1 1

Chemotherapy, 217

Chicago, 320,465

Chicago Area Project, 320, 321, 322, 328
Child care, 352

Child guidance movement, 318, 332
Child labor laws, 231
Children, disturbed, 66, 69, 74
treating the, 73
emotionally disturbed, 71
high-risk, 125
mental health of, 167
Child study center, 346
Children’s Manifest Anxiety Scale (CMAS),
186

Children, primary grade, 190
Children, residential treatment center for,
165

Cholera epidemic, 19 th century, 39, 43,
422

Cholera epidemics, 323

SUBJECT INDEX/481

Chrome mental patient, program for the
discharge of, 106
treatment of the, 105
Chronic mental patients, 381
City College Program, 350, 351, 364
City College student, 351
Gty planners, 306, 343
Gty planning, 340
Gvilwar, 281

Gasses in human relations, 160

“Gass Play,” (CP), 177, 180, 181, 182, 186

Gassroom, contingency management in,

168

Classroom management techniques, 168
Gergy, 400, 466

Gergymen, 36, 41 , 48, 78, 271 , 273, 360,
380

Client-centered case consultation, 272, 273
Clinic, well-baby, 47
Ginics, child guidance, 316, 317, 320
child health, 57, 58
maternity, 58
prenatal, 48
psychiatric, 58
satellite, 77
speech & hearing, 58
walk m, 49

Clinical psychologist, retraining of, 341
Clinical psychology, 35 1
Clinical psychology student, 274
Clinical psychology training, 339
Clinical psychology training program, 345,
349

CMAS, 190

College commumty, 224, 464
College community program, 465
College student companion programs, 66,
377, 378

College students, 202, 203, 222, 461
as companions to disturbed mental pa
tients, 374

College student volunteers, 62, 193
College undergraduates, 59
Colorado program, 356, 364
Colorado State, 219

Colorado State program, project, 220, 221
Colorado, University of, 355
community mental health training at, 355
Program, 356

Columbia, Maryland, 306, 307, 308, 310
Columbia plan, 309

Columbia Point Health Association, 398
Columbia Point Housing Project, 397
Commitment mechanisms, 295
Communal groups of the 19th century, 283
Communal living, experiments m, 279
Communal living situations, 280, 312
19th-century, 290
Communal living societies, 279
Communal nursery, 296
Communal society, 283
development of, 281
Commune, contempory, 299

missionary, 301
service, 301, 343
20th century, 304, 311
retreat, 300, 301
Commune movement, 280, 304
Commune members, 281
Communes, commitment mechanisms char
actenzing 19 th-century, 282
modem, 301,304, 306
modern-day, 299, 300

toth-century, 284, 285, 287, 288, 289,
2 Tj 2 ^ 2 : 294, 295, 299, 302. 304

Communion, 282, 286

Community, ,he

Community action 245

359

Commumty action agency, 253
Community action prop™

Community adjustment, 106, 112, 255

»mmS^“«’ Med t f “’ 2 2 2 5 9

s=miyS-.»n ,w ' 300

d- 2 Egl—

mg ground for, ZL»

Commumty leaders 350 4J7 ,s,

^ 00 ^ 27 !, 345 , 356 357 ,
358,359 360,361

research in, 421 ^aaa, 2 44

Community menta ^ h P iMch 21

Commumty mental toj| d centos, 4, 7,

Community menml he 1 4 g 2i 471

314, 40: ' 1 Health Centers Ad of

-ommunity Menla! He31
1963, 421

482/SUBJECT INDEX

Community mental health centers, compre-
hensive, 78, 356, 396
Community mental health field, 364
Community mental health movement, 34,
356

Community mental health practicum, 347,
348

Community mental health program, 341,
356, 358, 359, 370

Community mental health services, 204,

356

Commumty mental health specialist, 358
Community mental health specialists, pio-
neering training program, 357
Community mental health training, 347
Community mental health worker, 145
Communities, 19th-century, 286, 290, 295
Community organization, 338, 340
Commumty participation model, 415
Community & preventive approaches, bases
for opposing, 316
Community program, 229
for rehabilitating the poor, 228
Commumty programs, aims & purposes of
recent, 233

Commumty psychiatrists, 318
Commumty psychiatry, 112, 317, 319, 324,
325,328,331,458
criticism of, 317

Commumty psychiatry & psychology, train-
ing ground in, 76

Community psychologist, 132, 133, 148,
149, 204, 205, 223, 225, 315, 318,
3J9, 338 , 339 , 340 , 341 , 342 , 343 ,
348, 358, 365, 366, 421, 443, 452,
460, 461, 465, 467, 468, 469, 470
Commumty psychology, 144, 225, 233,
248, 310, 314, 317, 319, 325, 331,
334, 337, 338, 340, 341, 342, 344,
347, 350, 354, 355, 360, 362, 363,
365, 366, 394, 420, 421 , 422, 434,
435, 443, 444, 446, 451, 452, 458,
459, 460, 462, 463, 466, 467, 468,
469,470, 471,472

Commumty Psychology at the Gty College
of the City University of New York,
349

Commumty psychology, birth of modem,

339

current state of training in, 363, 365
Division of, 2

important issues facing, 122
professional training for, 341
training programs, 345, 352, 468
Community psychology literature, 19
Commumty psychology movement, 40
Commumty psychology program at George
Peabody College, 345

Community psychology programs, 243, 346
Commumty psychology students, 343
Community psychology training, 349
Community-relevant roles, 105
Commumty resistance, 150
Commumty services, 230
Compulsions, 1 1
Conflict-free spheres, 18
Connecticut Mental Health Center, 415,
418

Consciousness, 13

Consultants, 1, 158, 188, 195, 214, 215,
273, 306, 308, 338, 352, 353, 360,
361,362,364,386,409
child behavior, 159

school psychology graduate students as,

158

psychiatric, with social workers, 184
Consultation, 47, 51 , 65, 77, 78, 162, 271,
272, 274, 345, 374, 351, 352, 353,
354, 357, 359, 360, 361, 362, 363,
364

with commumty care-givers, 346
with family members, 50
group, with teachers & parents, 151
of a mental health professional, 175
psychiatric, 307

school mental health workers, 176
with teachers by mental health profes
sionals, 199
training for, 350
Consultation methods, 340
Consultation model, 158
Consultee-centered administrative consulta-
tion, 272

Consultee-centered case consultation, 272,
273

Consumer control, 416
Consumer participation, 416
Core group, the, 270, 382
Counseling, 234, 307, 328, 346
group, 371
individual, 371
Counseling program, 349

SUBJECT INDEX/483

Counselor, 234, 237, 238, 239, 240, 241,
242, 320

vocational rehabilitation, 332
Counselors, indigenous youths as, 349
to mothers of small children, 57
Courts, 466, 471
divorce, 48
Crime, 248, 274
Criminal offenders, 371
Crises, accidental, 44
developmental, 18, 44
family, 273, 274
nonnormative, 18
Crisis, health, coping, 47
preventing adverse emotional reactions to,
194

reaction to, 46
Crisis-coping, 48
Crisis hospitalization, 217
Crisis information, 307
Crisis intervention, 159, 220, 357
family, 352

in preschool & early school years, model
of, 194

Crisis intervention projects, campus, 222
Crisis resolution, in primary prevention, 44
Crisis situations, 273
Critical periods, 126
Culturally disadvantaged, 249
Cultures, Greek & Roman, 10
Curriculum, the Bulbs, 160, 161
Curriculum improvement, 159
Custodial care, 33, 82
cost of, 73

Custodial settings, 84
Custodial treatments, 34
Cybernetics, 445

Daily unit coordinator, 63
Data archives, 443
Day-care centers, 57, 350, 352, 413
Day-care facilities, government support, 132
Day-care program for primary grade school
children, 348
Dead Sea, 279
Decision theory, 445
Defense mechanisms, 13
Dehumanization, 279

Delinquency, 236. 237, 241, 242, 257, 269,
320, 321, 326, 359, 374, 379, 466
preventing, prevention, 233, 240, 242

Debnquency rates, reduction in, 322
Delinquents, 235, 236, 240, 241, 256, 258,
259,261,262, 271,320,321,322,
373

Delirious states, 9
Delirium, alcohobc, 9
Delirium tremens, 9
Delusions, grandiose, 9
Dementia praecox, 10
Demography, 359, 422, 444
Denver, 411

Denver Model Cities Program, 411
Depersonalization, 83
Depression, 9
Detection, early, 48, 21 3
Deviation(s), sexual, 14
Diagnostic and Statistical Manual Mental
Disorders 14
Dietary experiments, 281
Disadvantaged children, deficits observed in,

134

Disculturation, 112

Disease, concept of illness, 19

Disorder(s), behavior(al), 15, 16, 17,

mJZ.lO, 11,14 ,15, IS. I *.: ”- 13 ’

D.so,to ! ctoa 6 cter. 12.13, SM«

““MtiWlfom' factors m the etiology of.

121 ,,
etiology of, 42, 43

manifest, 328

personality, 13, 1 >

psychiatric, 35

as a physical disease, 109

prevalence of, 36

untreated mental, prevalent* of d *’' w

York City. 37

rates, 427

treatment of, 1 >8

used to prevent, '

vulnerably ■o.' 1 ”

Disorders, emotional, 324

484/SUBJECT INDEX

mental, assistance to those with, 77
neurotic, 33, 327, 429, 459
psychotic, 429
District of Columbia, 269
Disturbed, mentally, 16

community approaches to treating, 74
Divorce, 243

Dormitories, freshmen, 48
Draw-a-Person Test, 184
Drug addicts, 85
Drug administration, 76
Drug treatment, 33
Duke program, 211, 361, 364
Duke University, 210, 360, 361 , 364
Field Training in Community Psychology,

360

Duke University’s consultation program,

361

Duke University Medical Center, 361
Duke University training program, 362

Early childhood intervention research, re-
view of, 143

Early detection procedure, 198
Early identification, 198, 234
treatment of students’ psychological dis-
turbance, 216

Early identification procedure, effectiveness
of, 186

Early intervention, 131, 145, 199
decay of gams made through an, 138
impetus for, 132

practical difficulty associated with, 126
fcco behavioral science, 443, 444
Ecological approach, 434, 442, 448, 452,

Ecological model, 155 , 156, 340

Ecological system, 154

Ecological units, 438

Ecologist, 446
Ecology, 433,469

Economics, 338, 354, 366 444
Economists, 343

Education, 267, 315 34c
■m ’ ’

363, 364, 366,

Educators. 342, 360, 365

Ego, 12, 13. 17, i 8
Eliminating the unfit, 83
Emerson College, 64*

of, 182, 185

among students, rate of identified, 203
Emotional disturbance, 272
m children, early identification of, 177
prevention of, in children, 42
Emotional growth, 149
Emotionally disturbed children, 177
Emotionally handicapped children, 180,
182

Environment, constant, 441, 442
Environment, fluid, 441, 442
Environmental deficiencies, impact of, 1
Environmental force units, 437
Epidemiological approach, 448, 471
Epidemiological research, 433
Epidemiological studies, 461

Epidemiological studies of mental disorders,

427

Epidemiology, 340, 356, 357, 422, >

433.469

Epidemiology, psychiatric, 427, 429
Epileptic seizures, 9
Epilepsy, 9, 15

Epiphenomenal community, 403
Essenes, 279
Estabbshment, 20
Etiology of behavior disorder, 467
Evaluation, of accomplishment, 4
short term, 449
of technique, 447
ultimate, 449

Evaluative research, 347 , 447, 4 ,

450.451.452.469

in community psychology, 448
Ex-patient clubs, 77
External forces, role of, 330

Faith, test of, 290
Faith healers, 11
Family, extended, 299
Family problems, 27 3

Field assignments, 357
Field placements, 356, 363
Field stations, 443, 444
Field training, 362, 364
Field work, 363

Flagellants, 10 ^ -525

Florida, University of, 216, 21 .
project, 223

Foster home care, 76, 462
potential benefits, 76

SUBJECT INDEX/485

Foster home placements, 77
Free love, 284, 285
Free university, 224
Freshman orientation program, 216

Game theory, 445
Gemeinschaft, 401 , 403
General practitioners, 11, 271
Generalist, 339, 344, 365, 366, 468
* Generalized bastard,” 302, 303
Geography, 444
George Peabody College, 345
Center for Community Studies, 346
Geriatric facilities, 363
Gesellschaft, 401 , 403
Gheel, colony of, 74, 76
Ghetto, 309
Ghetto problems, 411
Goddard College, 215
Grade point averages, 186
Graduate students, 216, 231, 343, 345, 349,
352, 362

ui clinical psychology, 207, 208, 262
Gratification, delay of, 13
Greece, 329

centers of healing in, 15
“Gnckle," 112, 113, 114
Gnef, acute, 41

Group Assessment of Interpersonal Traits
(GAIT), 381
Group, encounter, 412
Group cohesion, 285
Group dynamics, 339, 342, 357
Groups, citizen, 46

Growth enhancing settings, creation of, 278
Guidance worker, 332, 333

Halfway house(s), 51, 65, 76, 214, 229
Halfway house for students, 213
Halifax County, 360
Halifax County program, 361
Harlem, 370

Harvard Medical School, 233, 358
Harvard Program, 358
H^ard School of Public Health, 357, 364
Harvard University, 260
Head Start, 133, 134, 135, 141
immediate goals, 133
impact of, 134
negative overall findings, 135
Planning of, 136

Head Start children, 134, 135
Head Start’s impact, study of, 133
Healthy community, the, 3
Helper therapy principle, 374, 387
High school dropouts, 269
Hill West Haven, 415
Hogg Foundation for Mental Health, 359
Home treatment services, 76, 462
Home visitor program, 1 36
Home visits, 235
Homeric writings, 9
Homicide, 243
Homosexuals, 218
Honzon House, 112
Hospital, day, rationale for the, 75
mental, modem, 83
as school for personality growth 84
workings of, 40
state mental, systems, 32
status hierarchy of the, 122
Hospital(s), day, 51 , 75, 96. 462

ientaJ,'^8, 81 , 82, 88, 314, 369, 370,
377, 462, 468

ight, 51,75,96, 462

ate, 317, 349, 429

eterans Administration, If

ipltal aide, 267
ipital as a social setting 121
ipital attendant, 110
ipital cate, changes in, 121
pital community, the, 81
pital life, 82

pital programs, open, 12
pital reforms, 81
pitahty index, 158
lines, 222

,Seb ' ea fl92 3 9 73,378,461,462
isewives,
child aides, 374

md University, 2 Propam
vard University New s-u

263 269,270.271.

rard University program, 2

374, 382

204 -xn «Q 433.443

aarreco'ogy.M^^rat.ono'Auw

484/SUBJECT INDEX

mental, assistance to those with, 77
neurotic, 33, 327, 429, 459
psychotic, 429
District of Columbia, 269
Disturbed, mentally, 16

community apptoaches to treating, 74
Divorce, 243

Dormitories, freshmen, 48
Draw-a Person Test, 184
Drug addicts, 85
Drug administration, 76
Drug treatment, 33
Duke program, 211, 361, 364
Duke University, 210, 360, 361, 364
Field Training in Community Psychology,

360

Duke University’s consultation program,

361

Duke University Medical Center, 361
Duke University training program, 362

Early childhood intervention research, re
view of, 143

Early detection procedure, 198
Early identification, 198, 234
treatment of students’ psychological dis
turbance, 216

Early identification procedure, effectiveness
of, 186

Early intervention, 131, 145, 199
decay of gams made through an, 138
impetus for, 132

practical difficulty associated with, 126
Eco behavioral science, 443, 444
Ecological approach, 434, 442, 448, 452,
471

Ecological model, 155, 156, 340
Ecological system, 154
Ecological units, 438
Ecologist, 446
Ecology, 433, 469
Economics, 338, 354, 366, 444
Economists, 343

Education, 267, 315, 345, 363, 364, 366,
373

Educators, 342, 360. 365
Ego, 12, 13, 17,18

Eliminating the unfit, 83
Emerson College, 64
Emotional disorders, m school children,
early Identification & prevention

of, 182, 185

among students, rate of identified, 203
Emotional disturbance, 272
in children, early identification of, 177
prevention of, in children, 42
Emotional growth, 149
Emotionally disturbed children, 177
Emotionally handicapped children, 180,

182

Environment, constant, 441, 442
Environment, fluid, 441, 442
Environmental deficiencies, impact of, 144
Environmental force units, 437
Epidemiological approach, 448, 471
Epidemiological research, 433
Epidemiological studies, 461
Epidemiological studies of mental disorders,
427

Epidemiology, 340, 356, 357, 422, 423,

433.469

Epidemiology, psychiatric, 427, 429
Epileptic seizures, 9
Epilepsy, 9, 15

Epiphenomenal community, 403
Essenes, 279
Establishment, 20
Etiology of behavior disorder, 467
Evaluation, of accomplishment, 447
short term, 449
of technique, 447
ultimate, 449

Evaluative research, 347, 447, 448, 449,

450. 451.452.469

in community psychology, 448
Ex patient clubs, 77
External forces, role of, 330

Faith, test of, 290
Faith healers, 1 1
Family, extended, 299
Family problems, 273
Field assignments, 357
Field placements, 356, 363
Field stations, 443, 444
Field training, 362, 364
Fieldwork, 363
Flagellants, 10

Florida, University of, 216, 217, 225
project, 223

Foster home care, 76, 462
potential benefits, 76

SUBJECT 1ND EX/487

aw, 345,362,369
aw enforcement agencies, 471

aw students, 343
awyers, 48, 78, 220, 272, 27

aisure-time activities, 102

Lincoln Hospital, 243, 244, 247, 406

S3SSS5SSS-

Lincoto Hmptrt Mental Health C^''^ 09
” So- Sconce Can-
ter Program, 243
Lobotomy, 33

Lodge Program, The, 105, H*

Lodges, 106
Lodge group, 107
altering, 253
andon, 422
Louisville group, the, 308
auisville plan, 309,310

Louisville planning group,
auisville planners, 309
awer class client, 333

Machiavellianism, 256

Magical practices, 16 33, 37

Manhattan, survey done m m
Mama, 9 , Training Act,

Manpower Development i Train.

371

Manpower problem, 389 JJ9

Manpower resource lrmit.tr

Marriage counselors, a/a

group, 284 Mental Hygtf ne »

Massachusetts Division of Me

358 * Technology. 20&

Massachusetts hj stl “ uh Ccn ter

Massachusetts MentatHea

(MMHC), 90, 95 center Pro

Massachusetts Mental H

gram, 90

Maternal child *****

Medical Assistant, 2b

Medical Associate, 268

5SSS5K— : 15

M Stmo.of-f 34 3

rssss*-" 5 - 4 *

beginnings of a sc.ent.fic modem, 15

public health, 22, 39, 40, 43, 422, 424,

public health model in, 22
Melancholia, 9

Menntnger Clime, 75

Menopausal women 48

^^">3,164,307,357,

411,428,446

nr coUegeL mno vatlve program*
ventive, 205
positive, 8, 148, 245

sss^ssiii 54

Of Students, promotmg the,

student, 223 243,397

Mental health agents, M3,

traditional, 57,33 , 349 374

Mental health aides, retire"

Mental health bene 1 pensive. 42 *

:s“s=£;’k’;r“

rsESss^-”''”'

273,338 ,.., 58,451

Mental health coun ^l° r trainees, 378
Mental health « ' nc tradmonal, 369

sag SrSsfS 1 ”

M=nJheaUJ^f^l4..9,20,| •
370^373?384^387, 389,416, 446,
459, 460, bettton of systems

-“■"S'—

M^iheatth films. I’ 4

486/SUBJECT INDEX

Human potential movement, 301
Human relations workshops, 273
Human service aides, 374, 379, 382
Human service field, 268, 271, 319, 382
Human service setting, 383
Human service workers, 271, 469
Humanism, 20 th century, 151
Humanistic philosophy, 218
Hyperactivity, 14
Hysteria, 10
theory of, 16
Hysterical complaints, 11
Hysterical symptom, 13
Hysterics, 11

Id, 12, 13, 17, 18
Illness, prevention of, 22
Impoverished, 267, 268
Impression management, 118
effectiveness of patient, 119
Incidence, 423, 426, 427
Incidence rate, 424
Indigenous nonprofessional, 375, 376
Indigenous worker, 321, 322, 343, 375, 387
Indigenous youth, 374
Indigent, 373
Individualism, 325
Industrial revolution, 229, 230, 465
Infants & preschool children, programs for,
125

Information theory, 445
Inner city, problems of, 243
Inner city ghetto, 444
Inner city youth, 249
Institutional caretakers, 129
Institutionalized children, programs for,
126,144

Institutionalized infants, social responsive
ness of, 131
Intelligence, 330
Intentional community, 280
Intern, 354, 355, 361, 362
Interpersonal relations laboratory, 113
Interprofessional power struggles, 20
Interprofessional rivalry, 20
Intervention, 155
home-based, 138

with mothers of the problem school child,
174

Interventions, family-centered, 143
home centered, 138

Intervention grounded in learning theory,
166

Interventive programs, 144
Investment, 282, 284
Involutional depression, 48
Iowa approach, 164
Iowa causal curriculum, 167
Iowa program, 162
Iowa training program, 164
Iowa, University of, 161
IQ, 127, 129, 134, 136, 138, 140, 141, 163,
165,177,180,197
Israel, 295,297,298,312
ITPA, 143

ITPA language test, 142

lews, 430
Job Corps 249
Job placement, 270
Joint Commission on Mental Illness &
Health, 2, 4, 32, 36, 38, 315, 316,
317,319,320,328,421
Joumahsm student, 343
Judaic sect, 279
Junior League, 95

Juvenile court, 256, 262, 321, 345, 359
Juvenile Court & Probation Department of
Austin & Travis Counties, 359
Juvenile courts, establishment of, 231
Juvenile Court System, New York City, 324
Juvenile delinquency, 233, 243, 261, 318,
465

Juvenile delinquents, 266
modeling procedures with, 261

Kansas program, 213
Kansas State project, 215
Kansas State University, 213
Kibbutz, 296,297,298,312
Kibbutz community, family structure in the,
296

Kibbutz ideology, 298
Kibbutz movement, 295
Kibbutzim, 311

Kindergarten pupil, child, 442, 443

Kindergartner, 442

Kirschner Associates, 135 (1970)

Kuhlmann Binet Intelligence Tests, 128

Labor Department, 371
Labor movement, 231

SUBJECT INDEX/489

recent developments in care of, 315
treatment of, 315
Mentally retarded, 72
centers for, 353
Metropolitan State Hospital, 62
Michigan project, 158
Michigan, University of. Survey Research
Center, 36

Middle Ages, The, 10,15
Midtown Manhattan Study, 429, 430
Midtown Study, 429, 431, 432, 433
Ministers, 231, 346, 362
Ministry, 369

Minneapolis, Minnesota, 401
Minnesota Multiphasic Personality Inventory
(MMPI), 210
Minority groups, 159
MIT, 210
MIT program, 207
MIT project, 207
MIT study, 210
MMHC program, 92, 93, 95
effects of the, 95

MMHC treatment program, long term effects
of the, 96
MMPI, 216

“Mobile sociahzer,” 119
Model(s), as guides to professional thinking
& practice, 19

Model, Caplan’s conceptual, 44
disease, 20, 21

medical, 19, 20, 21, 22, 23, 24. 337, 365,
460

preventive, 248
public health, 23, 24
Model for student structured college com
mumties, 224

Model of public health medicine, 150
Modeling approaches, 262
Modeling procedures effectiveness of, 265
Modeling situation, example of, 265
Moodiness, 14
Morbidity, force of, 424
Mortification, 282, 288, 289
Mother child relationship, 141
quality of, 1 40
Mount Wilson, 444
Multidisciplinary programs, 345

Nashville, Tenn , 346, 347, 427
National Institute of Mental Health,

32, 56, 194

Naturalistic phenomena, 444
Neighborhood Community Center, 345
Neighborhood Counseling Center, 346
Neighborhood mental health center 379
413

Neighborhood organization, 231
Neighborhood psychological centers, 350
Neighborhood Service Center (NSCs), 243,
247, 370, 383, 468

Neighborhood service center model, 342
Neighborhood welfare associations, 321
Neurosis(es), 11, 13, 240
character, 1 3, 459
symptom, 1 3
Neurotic, symptom, 1 3
Neurotic character 13
Neurotic patients, 30
Neurotics chronic, 85
Neurotic symptomatology , 31
New career concept, program, 267, 268,271
New careerists, a follow up evaluation, 270
New careers for the poor, 266
New Careers Movement, 266, 267, 268
New careers program, 374
New Haven, Connecticut, 156, 255, 428
New Haven program, 158
New York, 301

New York City, 230, 243, 273, 274, 401,

429

Newark Medical School controversy, 403
NIMH, 372

Nonprofessional, 78, 247, 249, 347, 370,

37 1, 373, 374, 380, 381, 382, 383,

384, 385, 386, 387, 388, 389, 406,

407, 408, 409, 468, 469, 470
college student, 377
in community psychology, 369
indigenous, 249, 370, 371, 384, 386, 388,
405,410,469

Nonprofessional child aides, 194, 381
Nonprofessional manpower in the schools
utilization of, 185

Nonprofessional mental health aides indige
nous to the neighborhood, 245
fionprofessionals, lower class indigenous,

372

middle class, 372

recruitment, training. & supervision of,

192

selection of, 377

488/SUBJECT INDEX

Mental health functions, manpower sources
for traditional, 59
Mental health manpower, 51, 374
Mental health manpower needs, 372
Mental health manpower problems, 39, 315
Mental health movement, 2, 372, 388
Mental health needs, 48, 59, 157, 243
of the nation, 315

Mental health orientation, traditional, 125

Mental health planners, 307

Mental health practicum for undergraduates,

349

Mental health principles, infusion of into
existing schools, 151
public, on a college campus, 216
Mental health problems, 36, 244, 271, 273,
274, 331, 338, 428, 430, 444, 460
ecological viewpoint toward, 435
prevalence of, 35
preventive approaches to, 323
traditional, 275

Mental health profession(s), 3, 4, 5, 6, 11,
14.21,22,23,32,36, 37,39,41,

318, 320, 322, 325, 332, 373, 374,
379,394,460,466

Mental health professions, manpower needs
of, 373

Mental health professional(s), 4, 9, 12, 14,
19, 21 , 34, 36, 37, 41 , 42, 47, 48, 68,
78, 82, 194, 221, 224, 249, 272, 273,
274.275,323,329,331,333,338,
341, 358, 372, 404,410, 431 , 459,
460, 461, 465, 466, 467, 470, 471
increasing the supply of, 38
role of, reshaping of, 188
Mental health program, 272, 273, 372, 373
school, 380

Mental health program evaluation, 356
Mental health ratings, 431
Mental health revolution, 11, 16
Mental health service centers, 405
Mental health services delivery, inequity in,
34

Mental health services, 59, 175, 243, 245,
273,342,369,403,446
demand for, 37, 38
in early school grades, 185
inequities, 51
need for, 37
in the colleges, 203
latent need for, 36, 460

potential demand for, 36, 51
school, 176
student, 203

Mental health setting, traditional, 315
Mental health specialists, 274
Mental health staff, 244
Mental health status, assessing, 429
Mental Health Study Act of 1955, 3, 32
Mental health training, 338
Mental health work, 47, 55, 387
Mental health worker(s), 4 , 6, 1 1 , 16, 23,
29, 34, 37, 47, 49, 77, 78, 132, 133,
150, 169, 177, 205, 213, 248, 275,
317, 318, 319, 320, 331, 333, 384,
386,388,461,465,467
subdoctoral, 471
supply & demand for, 38
Mental health worker, school, 176 , 185, 199
traditional, 366

Mental health workers’ efforts, targets of
the, 47

Mental Health Worker’s Union, 409
Mental hospital as a resort, 120
Mental hygiene movement, 315, 316, 320
Mental hygiene programs, effects of four
different, 161

Mental illness, 5, 6, 9, 21, 32, 33. 42, 44,
74, 83, 162, 166, 247, 324, 327, 374,
411,428,429

as the opposite of mental health, 20
nature of, 40
new ideas about, 314
prevention of, 40, 85, 166
primary prevention of, 317
progressively broadening definition of,

318

residual effects of, 50
traditional symptoms of, 121
Mental illness rates, 320
Mental illnesses, 319
Mental institution, studies done ui, 118
Mental patients, college companion pro-
grams for, 376
Mental retardation, 69, 308
Mentally disturbed, improving attitudes to-
ward the, 316

community involvement in the treatment
of, 315

Mentally ill, 3, 316,431
care of the, 38

improving the mental health of, 315

SUBJECT INDEX/491

Planned Communities, 306
Pleasure principle, 12
Poet, 343

Police, policemen, police officers, police de-
partments, 78, 271, 272, 273, 274,
350, 352, 359,362,466
Political action, 229, 248, 275
Political activist, 2
Political science, 338, 354, 366
Political scientists, 342
Politician, 466, 471
Poor, apathetic, 247
militant, 247

Population shift within the United States,
243

Positive growth, 9
Post partum psychoses, 9
Poverty, 248
Powerlessness, 83
Power structure, 3
Practitioners, private, 33
Pre delinquents, 233, 234, 235, 241
Pre-evaluative research, 449, 450
Preschool children, 463
intellectual growth in, 141
program aimed at fostering essential social
skills, 195

program for, 197
Preschool environments, special, i

Preschool evaluation, 195
Preschool intervention, 133, •

President’s Task Force on the Mentally
Handicapped, 316
Prevalence, 48, 49, 423, 426 428,
Prevalence rate, 424, 42 , 199

Preventing early identifie '

Prevention, 5, 9, 58, 166, 198, 204.
320,328, 353,461
commitment to, 316
early, 165

in the college community, 2U

'ZZZZSgi.™ «.*»■

159,173,174,215

as community concept, 42
ecological perspective, 4g

through interpersonal action,

or secondary, 213, 463 ^

secondary. an<l>e.t,ary,2 i5 . 7i59i

secondary, 42, 48.

173,199, 242

tertiary, 42, 50, 51, 54, 125, 156, 213

Prevention program, 463, 465
effects of, 190
effectiveness of, 328
for adults in the community, 228
interest in, 327

Preventive community programs, 6

Preventive consultation service, 273

Preventive efforts, 156, 451
community, 31

Preventive goals, secondary, 129

Preventive intervention, 3, 131, 149, 170,
207

Preventive, primary, impact, 47 ,48 59, 66

Preventive programs, 23, 132, 188, 19 ,

234, 324, 353
in the college setting, 464
development of, 316
effects of, 191
knowledge to establish, 316
objection to, 325
pioneer, 160

pnmmy! worth of, in the schools, 150
secondary, 45 1 , 464

Preventive psychiatry for student popula
tions, 203

Priests, 15 194

Primary mtervenfton approaches,

Pnmary prevention efforts 1 9

Primary prevention propa™, 169
establishing in existing schools, 1/u

tion, 126 - q

Pnmary preventive strategy, 129

Prison-asylum, 84

Probation department 359^

Probation officers, .

Problem Situation Test

Professionals, 249
care-giving, 48
middle class, 414

sSSssss*

245 .. ,,,

* Professional preaousness,

490/SUBJECT INDEX

supervision of, 354
as teacher-aides, 370
teenagers as, 370
training of, 381

Non-Red-Tag group (NRT), 185

Normative developmental problems, 162

North Carolina, 360

North Carolina, University of, 203, 215

Northfield Experiment, 85

Northfield Military Hospital, 85

Novelists, 231, 343

NRT, 186, 187, 188, 191

NSC, 243, 244, 245, 247, 248, 249

NSC program, 247

Nurses, 48, 88, 93, 235, 237, 271, 273, 346,
362, 370, 379
head, 95

integral part of the treatment team, 94
psychiatric, 38, 216, 217
psychiatric, optimal role, 94
public health, 77, 360
visiting, associations, 77, 350
Nurse referrals, 186
Nurses Settlement (Henry Street), 230
Nursing, 38, 345, 363, 364, 369
psychiatric, 39, 361
Nursing affiliates, 94
Nursing care, 230

Oberhn, 301
Obsession, 13

Obsessive-compulsive neurosis, 1 1
Obstetrician, 220, 306
Occupational adjustment, 255
Occupational rehabilitation & recreation, 84
Office of Economic Opportunity, 406
Ohio University, 133
Ombudsman, 342
Operant behavior, attention as, 109
Operant conditioning, 109, 111, 166
Operant environment, 114
effects of community-based, 115
Operant learning environment, 112
Operant program, 118
Orderliness, excessive, 14
Orientation, causal, 162
test of, 163, 164
noncausaj, 162
Orientation toward health, 2
Ovcrdepcndencc, 14

Pace I D Center, 182
Pace program, 184, 199
Pace project, 183
Paralyses, 10

Paranoid schizophrenia, 427
Paraprofessionals, 217, 398
Parents as helpmg agents, 138
Parent-child interactions, 141
training m, V4V
Parent-child relationships, 1 34
emotional tone of, 144
Parent child respect, importance of, 142
Parent education program, 307
Participant conceptualization, 338
Participant-conceptualizer, 2, 339
Participant observers, 155, 342
Patients, forgotten, 66
former hospital, 95
invisible, 119

mental, follow-up care for newly dis-
charged, 77
mental, 34
rehabilitation of, 74
paretic, 83
psychotic, 33
Patient committee, 88

Patient’s community adjustment, quality of,
96

Patient government, 93, 98, 99
Patient government, leadership, 93
Patient’s illness, family’s role in, 76
Pavlovian conditioning, 109
Peabody program, 345, 346
Pediatrician, 306
Pediatrics, 361

Personal growth, 279, 288, 299
Personal privacy, 324
Personality, the normal, 12
Personality development, theory of, 16
Perversions, sexual, 1 1
Perverts, sexual, 85
Petty theft, 253
Philadelphia, 410

Phillips Brooks House Association at Har-
vard, 62

Philosophy, 345, 362
Phobia(s), 11, 13
Photo Naming Test (PND, 10 0
Physicians, 36, 48, 235, 272, 273
as disciplinarian, 89
Greek, 15

SUBJECT INDEX/493

Rates, 423

Real estate developers, 306, 311
Recovery Incorporated, 373
Recreation aides, 270
Recruiter, 78
Red-Tag group (RT), 185
Re-ED program, 72, 73, 74
evaluations of the, 73
referrals to the, 71
teachers for the, 71
Re-ED school costs, 73
Re-ED school(s), 72, 78
Reformers, humanitarian, 81
Rehabilitation, occupational, 5 1
Reinforcement, negative, 260, 261
positive, 142, 260
primary, 111

Reinforcement patterns, 109
Rcmforcers, primary, 112, 113
Religious settlements, missions, 230
Renaissance, 16
Renunciation, 282, 285

Reporters, 231
Residence hall advisers, 204
Resident advisers, 207, 208, 209
Resident fellows, 213

Residential center for delinquent youth, 382

Residential treatment, cost of, 73

Residential treatment settings, 66, 462

Residential Youth Center (RYO, 249, 370

Resistance, ego, 13
Resistances, 13
Respondent conditioning, 109
Restraints, physical, 81
Revolutionary war, 281
Rochester Community Mental Health prac
ticum, 348, 349

Rochester Primary Mental Health Program,
177,191,194

Rochester Primary Mental Health Project,

184,188,193,199
Rochester program, 210, 364

Rochester, Umversityof. 207, 347, 349

Role'modelsni social-system change, 340

Role playing, 218 , 245, 273,

Rome, Imperial, 9

RT, 185, 186, 187 ’ 1 ® 8 ’ 1 25 5 256

RYC, 249, 250, 253, 254, »

RYC clients, 253

RYC program, 250, 252, 253, 254, 256
effects of, 255
RYC staff, 254
RYC residents, 256
RYC worker, 252

Sacrifice, 282, 283

St Louis Council for Parent Education, 174
St Louis program, 174, 175, 176, 199
St Louis Project, 173, 184
Salvation Army, 228, 229, 230, 465
San Mateo County, California, 182
Sanitation codes, 231
Schizoid personalities, 85
Schizoid withdrawal, 14
Schizophrenia, 10, 34, 126, 248, 308
Schizophremc(s), 3, 33, 59, 61, 83, 84, 99,
109,118

Schizophrenic, catatonic, 96
Schizophrenic child, 70
Schizophrenic reaction of childhood, 69
School adjustment, 192
School children, Negro & Puerto Rican, 351
School consultation program, 1 69
School experience as vital force in child’s
life, 147

School interventions, 156, 168
School maladjustment, early, 176
Schools, 49, 468
alternative, 169, 170
as a social system, 169
constant, 155

fluid, 155

mterventive efforts in elementary, 156
nursery, 57, 58, 345
private, 245
social system of, 170
hool problems, early detection of poten-
tial for, 176

hool setting, interventions aimed at alter

mg, 151

hool system, 352, 360
hool turnover, 155
iences, 373
lentists, 231

enlist subject relationship, 257
sondaiy prevention m the schools,
solidary preventive approach, 147
mndary preventive efforts with chddren,

;on dary preventive emphasis. 158

492/SUBJECT INDEX

Program-centered administrative consulta-
tion, 272

Program evaluations, 56

Program organizer, 78

Project Head Start, 133

Project Re-ED, 66, 71, 72

Projection technique, 86

Prophylaxis movement, the, 40

Protestants, 430

Pseudopatients, 82, 83

Psychiatnc adjustment, ratings of general,

103

Psychiatric case registers, 356
Psychiatric residents, 206
Psychiatnc symptoms, 35
Psychiatnsts, 36, 37, 38, 59, 206, 216, 235,
306, 319, 325, 332, 342, 379, 409,
413

child, 195

community, 5,6, 22
consulting, 190
fear of, 258
social, 6

Psychiatry, 9, 315, 345, 347, 357, 361, 364,
417,428

community, 5, 6, 7, 8, 21, 22, 54

forensic, 6

industrial, 6

preventive, 42

social, 7

Psychoanalysis, 12, 13, 28, 30. 41, 56, 330
Psychoanalytic technique, 12
Psychoanalytic theory, 12, 16, 17
Psychodrama, 86, 89,217
Psychological disturbance, college students,
incidence of, 203
prevention of, 168

Psychological dysfunction. Interventions to
reduce incidence of, 125
school as base in reducing prevalence of,
147

Psychological intervention, the campus as
laboratory for, 204
Psychological testing, 332
Psychological test instruments, 378
Psychological tests, 56, 198, 257
Psychologists. 36, 38. 93. 185. 192. 193.
194. 195.216. 220, 235, 237, 330.
332. 337. 338. 339. 347. 352, 379.
434, 435, 443, 444, 448, 452, 463,
469,472

clinical, 37, 337, 339, 345, 354, 471
community, 19, 20, 22, 24, 32, 40, 203
ego, 17, 18
school, 380

Psychology, 250, 267, 315, 330, 331, 340,
347, 358, 361, 362, 417, 433, 434
Psychology, abnormal, 28
clinical, 1, 9, 38, 356, 357, 358, 364, 471
community, 1, 2, 3, 9, 14, 18, 21, 23, 24,
28, 39,51

community clinical, 2
developmental, 471
educational, 346, 358
frontier, 326, 327
school, 346, 359

Psychology graduate students, 361
Psychology interns, clinical, 254
Psychoneurosis(es), 10, 12, 14, 29, 248,461
Psychoneurotics, 11, 16, 4 59
Psychopaths, 85
Psychopathology, 243
Psychosis(es), 11, 12, 14,461
Psychosocial adequacy, 160
Psychosomatic medicine, 12
Psychosomatic disorders, 14
Psychotherapist, 383, 431, 461
Psychotherapy, 29, 31, 33, 34, 41, 55, 56,
59,61,65,76,214,332, 339, 343,
347, 351, 352, 361, 370, 378, 387,
429,449,461
bnef, 357
directive, 33
effectiveness of, 29, 31
group, 59, 199, 206, 211, 217, 266, 351
individual, 328
intensive, 328, 329, 331
intensive analytic, 33
long term, 30
traditional, 71

Psychotherapy outcome, studies of, 30

Psychotics, 72, 85, 274, 327

Public health, 356, 357, 361, 388

Public health administrator, 306

Public health dentist, 306

Public health personnel, 307

Public information, programs of. 31 6

Public schools, 78, 350

Public school system, 66, 360. 363. 366

Puerto Rico, 301

Quacks, 11

Student turnover, 441
Suicide, 243
Suicide prevention, 220
Suicide prevention agency, service, center,
221,361,362
Summerhill School, 169
Sumter Child Study Project, 194, 198, 199
Sumter County, South Carolina, 194
Superego, 12

Supernatural forces, 14, 16
Supernatural power, 15
Supervisor, 78

Supplies, basic, increasing, 48
physical, 43, 45
psychosocial, 44, 45
sociocultural, 44, 45
Surrogate mother, 129
Synanon, 301, 302, 373
System change, 350

Systems analysis, 446
Systems analysis approach, lW.

System analysis techniques, 452

TAY, 177, 180, 181

T groups, 254,351,352,363

Teachers, 48, 271, 273, 35 2

Teacher aides (TA), 192, 193, 1 ,

200, 270, 380, 383, 385

Teacher-counselors, 71, 72
Teacher, liason, 72
Teacher-mom (s), 67, 68, 69, 3
Teachers, school, 272

selection of, 162 .

Telephone crisis centers, campus.

Telephone hotline,

Temperamental types, 329 .

Temple University Community Mental
Health Center, 409
Tertiary preventive efforts,

Texas program, 358, 360,

Health Training, 308

Theology, 362 g4 g 5> g6> 88,

doctor'nurse relationship m, 89
staff roles in the, 88
doctor’s role in, 89

leader’s role in a. 90

•Therapist, group. 37

SUBJECT INDEX/495

Therapists, group, untrained college students

as, 62

occupational, 59,93
social, 98

socio-envuonmental, 370
speech, 195, 197, 332
trained, 60
untrained, 60, 61
Therapies, cathartic, 330
Therapy, activity group, 371
family, 354
filial, 382

group, 6, 61, 94, 98, 99, 158,162, 164,

174, 175, 354,412,461
group, effectiveness of, 62
group, effects of the, 59
helper principle, 373
individual, 217, 354
occupational, 74, 92, 99
physical, 15
play, 382
recreational, 74

"Thinking About Yourself (TAY). >”•
180,186

Time Magazine, 398 ,

Token economy, 108, 109, i

on open ward, 111
Token reinforcements, 1
Total education milieu, 7

Total school atmosphere, 151

Trainee selection, enter* of, 56
Trainer, 78

Training program, 5b , 22

Tranqudrrers, widespread u« of, 1

Transcendence, 282, m uny> 46

r.l",8i,82,83,84,.09,.2.

Mcd-3 school. 39T

Tutoring, 371

Twin ° jks ’ ^rtatron of, 284

Two-person intimacy, b

Typhoid epidemics. 5/a

Unconditioned stimulus, 109

Unconscious, 1 3
Unconscious forres.'-’

Unemployment. 24 J

494/SUBJECT INDEX

Secondary preventive intervention, 174
Secondary preventive program, 177, 199,
200

Secondary preventive programs, pioneering
school, 173
Self-actualization, 279
Self fulfilling prophecy, 442
Self-help organizations, 373
Sensitivity training, 343, 3S3, 382
Separation, 243

Settlement houses, 229, 231, 232, 233, 243,
349

church role in early development, 229
earliest American, 230
Settlement house development, 233
Settlement House Movement, 229, 230,
233,243,465

Settlement house movements, English &
American, 248

Settlement house workers, 230, 231
Sexual abstinence, 282
Shakers, The, 294
Shamans, 15

Sheltered workshops, 231
Shock treatment, 33

Silver Achievement Award of the American
Psychiatric Association, 405
Small pox, 43
Social action, 231, 245
Social adjustment, 105
measure of, 103

related to hospital treatment, 104
Social adrenaline, 121
Social a^ncwa , 255
Social case workers, 37, 234
Social change, 244
agents of, 338
Social class(es), 33, 34
Social desirability, 256
Social forces, 5
significance of, 17
Social interaction, 114
Social isolation, 101, 427
Social legislation, 248
Social living situation, 97
optional, 305

Social maladjustment, 242, 256
Social reeds, resurgence of broad, 233
Social promotions, 176
Social psychiatry, 5, 6, 458
Social psychological theory, 17

Social psychologists, 337, 341, 433
Social psychology, 422, 471
Social reference groups, 105
Social reforms, 231, 299
Social regularities, 17
Social responsiveness, changes in, 130
Social sciences, 315, 339, 364, 366
Social scientists, 37, 148, 311, 341, 365
Social structures, attempts to create essen-
tially new, 278
Social system (s), 3, 7, 342
Social systems analysts, 1
Social system theory, 340
Social welfare measures, 231
Social work, 22, 38, 88, 250, 315, 332, 357,
362,364,417
Social work education, 306
Social work program in a housing project,
345

Social worker(s), 36, 38, 48, 59, 72, 93,
174,183, 185,186, 192, 193, 194,
235, 237, 321, 379, 395, 397, 466
preventive services of, 182
professional, 234

psychiatric, 37, 38, 41, 77, 195, 332
Socialist communities, 19th century, 279
Sociodrama, 161
Socioeconomic classes, low, 34
lower, 45

Socio environmental treatment, 97, 104,

105

criteria used to evaluate, 100
Sociologists, 337, 342, 343, 365
Sociology, 25b, 333. 345, 347 , 354, 358,
359, 361, 363, 364, 366, 422, 433,
471

Somerville, Massachusetts, 234
South Bronx, 243, 244
South Shore Mental Health Center, 1
Soviet Union, 325

Specialist versus generalist training, 340,

341

Specific, a, 132
Stanford-Bmet, 143
Statistics, 422

Stirling County, Nova Scotia, 428
Storefront service center, 405
Street comer research, evaluation of, 259
Street-comer and storefront experimenter-
subject collaborations, 261
Students for a Democratic Society, 409

496/SUBJECT INDEX

Unemployment insurance, 231
Umons, 350
United States, 356,430
Umted States Census Bureau, 203
United States Employment Service, 268
University community, 468
Urban ghettos, 231, 274
Urban ghetto dweller, 243
Urban planner, 311, 350
Urban planning, 338
Urban poor, 411
Urban renewal, 248, 435
Urban Study Center of the University of
Louisville, 308

Utopian Communities, 19th century, 280,
281, 283, 292, 293, 294, 296, 311
Utopian commumty, 279, 280, 281, 282,
294, 299, 301, 303
20th-century, 295, 301
Utopian ideals, 279
Utopian, 19th century, 299
present-day, 299

Utopian Societies, 279, 280, 293, 300
19th century American, 297
Utopias, 286
19th-century, 294

Venereal disease, 243
Virginia, 301

Visiting Nurse Service, 230
Vocational adjustment, 104
Volunteer auxiliary group, development of
a, 95

Volunteer, college students, 348, 369, 381
student, 213
student, program, 45 1
Voter registration campaigns, 248

Walden II, 302
War on Poverty, 252
Ward attendants, 94
Washington, 307
Washington, D C , 379
Welfare agency, 388
Welfare aides, 270
Welfare department, 345, 350
Welfare workers, 271, 272, 360
Wellesley, Massachusetts, 358
Wellesley, Mass , community mental health
program m, 42
Wellmet House, 65

Westinghouse Learning Corporation, 133
Westinghouse/Ohio report, 135
Westmghouse/Ohio Study, the, 133, 134
Westinghouse/Ohio Study group, 135
Westinghouse/Ohio team, 134
Williamson County, 427
Witchcraft, 16
Woods Hole, 444
Work programs, 92
Workman’s compensation, 231
Workshop, intensive, 113
World Health Organization, 6
World War II, 240, 255
Writers, 231

Yale, 352, 364

Commumty Psychology at, 352, 354, 355
Yale Psychiatric Clinic, 75
Yale Psycho-Educational Clime, 352, 353
Yale Umversity students, 253
YMCA, 230
Yoga, practice of, 281

Zen macrobiotic life-style, 301